Healthcare Provider Details

I. General information

NPI: 1588113088
Provider Name (Legal Business Name): GKN RX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7072 N CEDAR AVE
FRESNO CA
93720-3300
US

IV. Provider business mailing address

7072 N CEDAR AVE
FRESNO CA
93720-3300
US

V. Phone/Fax

Practice location:
  • Phone: 559-321-8608
  • Fax: 559-472-3103
Mailing address:
  • Phone: 559-321-8608
  • Fax: 559-472-3103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY54458
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHANDRA KADIYALA
Title or Position: CEO
Credential:
Phone: 509-392-1958