Provider Demographics
NPI:1578086815
Name:KC PHARMA LLC
Entity Type:Organization
Organization Name:KC PHARMA LLC
Other - Org Name:LTC RAY'S DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KHALIL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAHINE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:734-432-2015
Mailing Address - Street 1:37672 PROFESSIONAL CENTER DR STE 130B
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1140
Mailing Address - Country:US
Mailing Address - Phone:734-432-2015
Mailing Address - Fax:
Practice Address - Street 1:37672 PROFESSIONAL CENTER DR STE 130B
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1140
Practice Address - Country:US
Practice Address - Phone:734-432-2015
Practice Address - Fax:734-432-2016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301010939333600000X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy