Provider Demographics
NPI:1598273989
Name:KK & SS HEALTHCARE INVESTMENTS, LLC
Entity Type:Organization
Organization Name:KK & SS HEALTHCARE INVESTMENTS, LLC
Other - Org Name:PHARM HOUSE DRUG - SONORA LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KUBOSH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:979-218-4735
Mailing Address - Street 1:4941 REIGER AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214
Mailing Address - Country:US
Mailing Address - Phone:979-218-4735
Mailing Address - Fax:
Practice Address - Street 1:417 US 277 N
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:TX
Practice Address - Zip Code:76950
Practice Address - Country:US
Practice Address - Phone:325-387-2541
Practice Address - Fax:325-387-5423
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAK HEALTH HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-19
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149783Medicaid