Provider Demographics
NPI:1407108541
Name:KCAID PHARMACY INC
Entity Type:Organization
Organization Name:KCAID PHARMACY INC
Other - Org Name:PREFERRED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KOZLIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-872-7717
Mailing Address - Street 1:1771 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-1611
Mailing Address - Country:US
Mailing Address - Phone:718-872-7717
Mailing Address - Fax:718-872-7718
Practice Address - Street 1:1771 BROADWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207
Practice Address - Country:US
Practice Address - Phone:718-872-7717
Practice Address - Fax:718-872-7718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5806332OtherNCPDP
5806332OtherNCPDP
NY6724190001Medicare NSC