Provider Demographics
NPI:1669483244
Name:KER PHARMACY
Entity Type:Organization
Organization Name:KER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NARAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KERAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-474-0590
Mailing Address - Street 1:PO BOX 500647
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92150-0647
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1610 E 8TH ST
Practice Address - Street 2:STE A
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2780
Practice Address - Country:US
Practice Address - Phone:619-474-0590
Practice Address - Fax:619-474-7250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY42101333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0548694OtherOTHER ID NUMBER-COMMERCIAL NUMBER
CAPH421010Medicaid