Provider Demographics
NPI:1679566517
Name:PHARMKEE INC.
Entity Type:Organization
Organization Name:PHARMKEE INC.
Other - Org Name:PLAZA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:559-846-9396
Mailing Address - Street 1:15051 W WHITESBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:KERMAN
Mailing Address - State:CA
Mailing Address - Zip Code:93630-1013
Mailing Address - Country:US
Mailing Address - Phone:559-846-9396
Mailing Address - Fax:
Practice Address - Street 1:15051 W WHITESBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:KERMAN
Practice Address - State:CA
Practice Address - Zip Code:93630-1013
Practice Address - Country:US
Practice Address - Phone:559-846-9397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54001332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA54001OtherSTATE OF CALIFORNIA HOME MEDICAL DEVICE RETAIL LICENSE
CA54001OtherSTATE OF CALIFORNIA HOME MEDICAL DEVICE RETAIL LICENSE