Provider Demographics
NPI:1528284411
Name:PKN LLC
Entity type:Organization
Organization Name:PKN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:828-692-6554
Mailing Address - Street 1:2315 ASHEVILLE HWY STE 50
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-1561
Mailing Address - Country:US
Mailing Address - Phone:828-692-6554
Mailing Address - Fax:828-692-3201
Practice Address - Street 1:2315 ASHEVILLE HWY STE 50
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-1561
Practice Address - Country:US
Practice Address - Phone:828-692-6554
Practice Address - Fax:828-692-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3472963OtherNCPDP #
NC3419391OtherNCPDP #
NC7700682Medicaid