Provider Demographics
NPI:1205672359
Name:KAILASHRX LLC
Entity type:Organization
Organization Name:KAILASHRX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAYESH
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-259-5435
Mailing Address - Street 1:1240 PROVIDENCE BLVD UNIT # 1 & 2
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725
Mailing Address - Country:US
Mailing Address - Phone:386-259-5435
Mailing Address - Fax:386-259-9582
Practice Address - Street 1:1240 PROVIDENCE BLVD UNIT # 1 & 2
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725
Practice Address - Country:US
Practice Address - Phone:386-259-5435
Practice Address - Fax:386-259-9582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy