Provider Demographics
NPI:1942297981
Name:K N PHARMACY
Entity Type:Organization
Organization Name:K N PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NGUYEN
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:CHIEM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:626-280-3985
Mailing Address - Street 1:9246 VALLEY BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1922
Mailing Address - Country:US
Mailing Address - Phone:626-280-3985
Mailing Address - Fax:626-280-5839
Practice Address - Street 1:9246 VALLEY BLVD
Practice Address - Street 2:STE B
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1922
Practice Address - Country:US
Practice Address - Phone:626-280-3985
Practice Address - Fax:626-280-5839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY36078183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA360780Medicaid