Healthcare Provider Details

I. General information

NPI: 1275437337
Provider Name (Legal Business Name): KANURRA PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 W MAIN ST STE 100L
BOISE ID
83702-5789
US

IV. Provider business mailing address

315 W 86TH ST APT 10E
NEW YORK NY
10024-3173
US

V. Phone/Fax

Practice location:
  • Phone: 917-670-0993
  • Fax:
Mailing address:
  • Phone: 917-670-0993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. SEMIH GULTEKIN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 914-439-8620