Provider Demographics
NPI:1457600215
Name:KAN PHARMACY INC
Entity Type:Organization
Organization Name:KAN PHARMACY INC
Other - Org Name:CARE RX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-261-9888
Mailing Address - Street 1:302 E BULLARD AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5299
Mailing Address - Country:US
Mailing Address - Phone:559-261-9888
Mailing Address - Fax:559-261-9487
Practice Address - Street 1:302 E BULLARD AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5299
Practice Address - Country:US
Practice Address - Phone:559-261-9888
Practice Address - Fax:559-261-9487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-07
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY510493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136953OtherPK