Provider Demographics
NPI:1427356294
Name:KNB PHARMACY INC
Entity Type:Organization
Organization Name:KNB PHARMACY INC
Other - Org Name:COOLEY HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:BINH
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-514-1730
Mailing Address - Street 1:1280 E COOLEY DR
Mailing Address - Street 2:SUITE #23
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3932
Mailing Address - Country:US
Mailing Address - Phone:909-514-1730
Mailing Address - Fax:909-514-1316
Practice Address - Street 1:1280 E COOLEY DR
Practice Address - Street 2:SUITE #23
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3932
Practice Address - Country:US
Practice Address - Phone:909-514-1730
Practice Address - Fax:909-514-1316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY506383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1427356294Medicaid
2129589OtherPK