Healthcare Provider Details

I. General information

NPI: 1245264175
Provider Name (Legal Business Name): KPS CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 06/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8851 CENTER DR STE 110
LA MESA CA
91942-3017
US

IV. Provider business mailing address

8851 CENTER DR STE 110
LA MESA CA
91942-3017
US

V. Phone/Fax

Practice location:
  • Phone: 619-461-8551
  • Fax: 619-461-8553
Mailing address:
  • Phone: 619-461-8551
  • Fax: 619-461-8553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number52528
License Number StateCA

VIII. Authorized Official

Name: KETAN PATEL
Title or Position: CFO
Credential:
Phone: 619-461-8551