Healthcare Provider Details

I. General information

NPI: 1033596739
Provider Name (Legal Business Name): KGSS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2015
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 ARNEILL ROAD STE D
CAMARILLO CA
93010-6433
US

IV. Provider business mailing address

424 ARNEILL ROAD STE D
CAMARILLO CA
93010-6433
US

V. Phone/Fax

Practice location:
  • Phone: 805-383-8340
  • Fax: 805-383-8343
Mailing address:
  • Phone: 805-383-8340
  • Fax: 805-383-8343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. KHATCHATUR SARAFIAN
Title or Position: PRESIDENT/CEO/SECRETARY/DIRECTOR
Credential: PHARM D
Phone: 805-383-8340