Provider Demographics
NPI:1104430750
Name:KSH RX LLC
Entity type:Organization
Organization Name:KSH RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN MICHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MUDIAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-234-7049
Mailing Address - Street 1:2442 LILLIAN MILLER PKWY STE 115
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-2902
Mailing Address - Country:US
Mailing Address - Phone:940-536-0460
Mailing Address - Fax:940-536-0461
Practice Address - Street 1:2442 LILLIAN MILLER PKWY STE 115
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-2902
Practice Address - Country:US
Practice Address - Phone:940-536-0460
Practice Address - Fax:940-536-0461
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLANK APOTHECARY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-01
Last Update Date:2020-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy