Provider Demographics
NPI:1417932807
Name:KHANH PHARMACY
Entity Type:Organization
Organization Name:KHANH PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST, PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:619-280-0199
Mailing Address - Street 1:4575 EL CAJON BLVD.
Mailing Address - Street 2:STE#C
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-4390
Mailing Address - Country:US
Mailing Address - Phone:619-280-0199
Mailing Address - Fax:619-280-0089
Practice Address - Street 1:4575 EL CAJON BLVD.
Practice Address - Street 2:STE#C
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-4390
Practice Address - Country:US
Practice Address - Phone:619-280-0199
Practice Address - Fax:619-280-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 46144183500000X
CATCH 31900183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Not Answered183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY454530Medicaid