Healthcare Provider Details

I. General information

NPI: 1689853095
Provider Name (Legal Business Name): KEVITHAN CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2173 PICKWICK DR
CAMARILLO CA
93010-6426
US

IV. Provider business mailing address

2173 PICKWICK DR
CAMARILLO CA
93010-6426
US

V. Phone/Fax

Practice location:
  • Phone: 805-389-5311
  • Fax:
Mailing address:
  • Phone: 805-389-5311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY48914
License Number StateCA

VIII. Authorized Official

Name: DENA FERMAN
Title or Position: THIRD PARTY PLAN COORDINATOR
Credential:
Phone: 314-993-6000