Provider Demographics
NPI:1649672809
Name:D & K BROTHERS INC
Entity type:Organization
Organization Name:D & K BROTHERS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / PIC
Authorized Official - Prefix:
Authorized Official - First Name:ASHRAF
Authorized Official - Middle Name:
Authorized Official - Last Name:ELGAMAL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:909-527-3047
Mailing Address - Street 1:10431 LEMON AVE
Mailing Address - Street 2:STE G
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-3700
Mailing Address - Country:US
Mailing Address - Phone:909-493-1500
Mailing Address - Fax:909-493-1501
Practice Address - Street 1:10431 LEMON AVE STE G
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91737-3763
Practice Address - Country:US
Practice Address - Phone:909-493-1500
Practice Address - Fax:909-493-1501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-19
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY519163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2148019OtherPK
CA1649672809Medicaid