Provider Demographics
NPI:1124506498
Name:KANIF GROUP LLC
Entity type:Organization
Organization Name:KANIF GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:NGA
Authorized Official - Middle Name:HOANG
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:228-424-2086
Mailing Address - Street 1:P.O. BOX 4445
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39535-4445
Mailing Address - Country:US
Mailing Address - Phone:228-207-0960
Mailing Address - Fax:228-207-2787
Practice Address - Street 1:2709 25TH AVENUE
Practice Address - Street 2:UNITS C&D
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-4834
Practice Address - Country:US
Practice Address - Phone:228-357-5353
Practice Address - Fax:228-357-5354
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KANIF GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-30
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS171891.13336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy