Provider Demographics
NPI:1922177872
Name:AK PHARMA, INC.
Entity Type:Organization
Organization Name:AK PHARMA, INC.
Other - Org Name:VALLEY DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KARIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-967-2301
Mailing Address - Street 1:17313 E VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-5653
Mailing Address - Country:US
Mailing Address - Phone:626-964-2301
Mailing Address - Fax:626-912-4042
Practice Address - Street 1:17313 E VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-5653
Practice Address - Country:US
Practice Address - Phone:626-964-2301
Practice Address - Fax:626-912-4042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA445780Medicaid
1995218OtherPK
1995218OtherPK