Provider Demographics
NPI:1548378227
Name:KV EARLY IND
Entity Type:Organization
Organization Name:KV EARLY IND
Other - Org Name:CANTUS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERASMO
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-544-6666
Mailing Address - Street 1:1080 E LOS EBANOS BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-9988
Mailing Address - Country:US
Mailing Address - Phone:956-542-6050
Mailing Address - Fax:956-544-5539
Practice Address - Street 1:680 PAREDES LINE RD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-2482
Practice Address - Country:US
Practice Address - Phone:956-542-6050
Practice Address - Fax:956-544-5539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX183223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4501967OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TX144640Medicaid
5198640002Medicare NSC