Provider Demographics
NPI:1699505701
Name:KKN PHARMACY CORPORATION
Entity type:Organization
Organization Name:KKN PHARMACY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIHAR
Authorized Official - Middle Name:NIRANJAN
Authorized Official - Last Name:MANDAVIA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:949-643-0740
Mailing Address - Street 1:27881 LA PAZ RD STE E
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-3927
Mailing Address - Country:US
Mailing Address - Phone:949-643-0740
Mailing Address - Fax:949-643-2287
Practice Address - Street 1:27881 LA PAZ RD STE E
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-3927
Practice Address - Country:US
Practice Address - Phone:949-643-0740
Practice Address - Fax:949-643-2287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy