Healthcare Provider Details

I. General information

NPI: 1740807700
Provider Name (Legal Business Name): KSH RX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2442 LILLIAN MILLER PKWY STE 115
DENTON TX
76205-2902
US

IV. Provider business mailing address

2442 LILLIAN MILLER PKWY STE 115
DENTON TX
76205-2902
US

V. Phone/Fax

Practice location:
  • Phone: 940-536-0460
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: FUZIE TANGYIE
Title or Position: PHARMACIST IN CHARGE
Credential: RPH
Phone: 940-536-0460