Provider Demographics
NPI:1457538381
Name:KERN INFUSION SERVICES INC
Entity Type:Organization
Organization Name:KERN INFUSION SERVICES INC
Other - Org Name:PANAMA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:KAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:661-664-8864
Mailing Address - Street 1:4004 PANAMA LN
Mailing Address - Street 2:STE 100
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-3769
Mailing Address - Country:US
Mailing Address - Phone:661-664-8864
Mailing Address - Fax:661-831-1343
Practice Address - Street 1:4004 PANAMA LN
Practice Address - Street 2:STE 100
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-3769
Practice Address - Country:US
Practice Address - Phone:661-664-8864
Practice Address - Fax:661-831-1343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY501773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5629691OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CA1457538381Medicaid
6084010001Medicare NSC