Provider Demographics
NPI:1770649048
Name:BK PHARMACY CORP
Entity type:Organization
Organization Name:BK PHARMACY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHARM.D
Authorized Official - Prefix:MR
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:
Authorized Official - Last Name:KONG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:559-325-6581
Mailing Address - Street 1:540 E HERNDON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2993
Mailing Address - Country:US
Mailing Address - Phone:559-438-9888
Mailing Address - Fax:559-438-0118
Practice Address - Street 1:7509 N WILLOW AVE STE 105
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0345
Practice Address - Country:US
Practice Address - Phone:559-325-6581
Practice Address - Fax:559-438-0118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY50429332B00000X, 333600000X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5625009OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CA1770649048Medicaid