Healthcare Provider Details

I. General information

NPI: 1487405676
Provider Name (Legal Business Name): KGSS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 ARNEILL RD STE D
CAMARILLO CA
93010-6433
US

IV. Provider business mailing address

424 ARNEILL RD STE D
CAMARILLO CA
93010-6433
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KHATCHATUR SARAFIAN
Title or Position: PRESIDENT
Credential: PHARM.D.
Phone: 818-309-2233