Provider Demographics
NPI:1386001238
Name:KINDCARE PHARMACY AND MEDICAL SUPPLY
Entity Type:Organization
Organization Name:KINDCARE PHARMACY AND MEDICAL SUPPLY
Other - Org Name:KINDCARE PHARMACY AND MEDICAL SUPPLY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-592-3917
Mailing Address - Street 1:230 WALNUT ST STE B
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-5280
Mailing Address - Country:US
Mailing Address - Phone:530-592-3917
Mailing Address - Fax:530-809-1936
Practice Address - Street 1:230 WALNUT ST STE B
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-5280
Practice Address - Country:US
Practice Address - Phone:530-592-3917
Practice Address - Fax:530-809-1936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-23
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CA533483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157761OtherPK
CA1386001238Medicaid