Provider Demographics
NPI:1932968757
Name:KAILASH PHARMACY LLC
Entity Type:Organization
Organization Name:KAILASH PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TEJAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:713-992-3289
Mailing Address - Street 1:3755 S NOVA RD STE A
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-4282
Mailing Address - Country:US
Mailing Address - Phone:713-992-3289
Mailing Address - Fax:386-256-3177
Practice Address - Street 1:1107 N NOVA RD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-4108
Practice Address - Country:US
Practice Address - Phone:713-992-3289
Practice Address - Fax:386-256-3177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy