Provider Demographics
NPI:1376201947
Name:KSGS RX INC
Entity Type:Organization
Organization Name:KSGS RX INC
Other - Org Name:OAKS COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/RPH
Authorized Official - Prefix:DR
Authorized Official - First Name:KHATCHATUR
Authorized Official - Middle Name:
Authorized Official - Last Name:SARAFIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:747-254-3331
Mailing Address - Street 1:21910 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1724
Mailing Address - Country:US
Mailing Address - Phone:747-254-3331
Mailing Address - Fax:747-254-3332
Practice Address - Street 1:21910 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1724
Practice Address - Country:US
Practice Address - Phone:747-254-3331
Practice Address - Fax:747-254-3332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-01
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY57873OtherBOARD OF PHARMACY