Provider Demographics
NPI:1598356883
Name:KUSH PHARMACY LLC
Entity Type:Organization
Organization Name:KUSH PHARMACY LLC
Other - Org Name:LEBANON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:ANILKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:301-801-2435
Mailing Address - Street 1:633 WARMINSTER LN
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-5005
Mailing Address - Country:US
Mailing Address - Phone:717-775-5108
Mailing Address - Fax:717-775-3501
Practice Address - Street 1:990 ISABEL DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7483
Practice Address - Country:US
Practice Address - Phone:717-775-5108
Practice Address - Fax:717-775-3501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy