Provider Demographics
NPI:1508403841
Name:KC PHARMACY CORPORATION
Entity Type:Organization
Organization Name:KC PHARMACY CORPORATION
Other - Org Name:KC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PRESIDENT, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NHUONG
Authorized Official - Middle Name:KICH
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:602-596-9958
Mailing Address - Street 1:2060 ABORN RD STE 150B
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1587
Mailing Address - Country:US
Mailing Address - Phone:408-400-4755
Mailing Address - Fax:408-868-2326
Practice Address - Street 1:2060 ABORN RD STE 150B
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1587
Practice Address - Country:US
Practice Address - Phone:408-400-4755
Practice Address - Fax:408-868-2326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-05
Last Update Date:2019-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA57447OtherBOARD OF PHARMACY LICENSE