Provider Demographics
NPI:1851901607
Name:KC PHARMACY HEALTHMART INC
Entity Type:Organization
Organization Name:KC PHARMACY HEALTHMART INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GIHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SERAKA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:703-339-9599
Mailing Address - Street 1:8988 LORTON STATION BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-4757
Mailing Address - Country:US
Mailing Address - Phone:703-339-9599
Mailing Address - Fax:
Practice Address - Street 1:8988 LORTON STATION BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-4757
Practice Address - Country:US
Practice Address - Phone:703-339-9599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy