Provider Demographics
NPI:1407925357
Name:K AND R UNITED CORP
Entity Type:Organization
Organization Name:K AND R UNITED CORP
Other - Org Name:MEDILANE DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:212-505-1788
Mailing Address - Street 1:227 AVENUE B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-3358
Mailing Address - Country:US
Mailing Address - Phone:212-505-1788
Mailing Address - Fax:212-505-1976
Practice Address - Street 1:227 AVENUE B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-3358
Practice Address - Country:US
Practice Address - Phone:212-505-1788
Practice Address - Fax:212-505-1976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0249453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02122163Medicaid
2062906OtherPK
5264700001Medicare NSC