Provider Demographics
NPI:1710504550
Name:KAYSHUV ENTERPRISES, LLC
Entity Type:Organization
Organization Name:KAYSHUV ENTERPRISES, LLC
Other - Org Name:WEST PASCO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MANOGNA
Authorized Official - Middle Name:CHOUDARY
Authorized Official - Last Name:PAMIDI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:509-567-7160
Mailing Address - Street 1:7505 SANDIFUR PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7505 SANDIFUR PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301
Practice Address - Country:US
Practice Address - Phone:509-567-7160
Practice Address - Fax:509-567-7178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-27
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy