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General NPI Number Information
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NPI Number | 1124506498
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Entity Type | Organization
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Legal Business Name | KANIF GROUP LLC
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Dates
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Enumeration Date | 07/30/2018
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Last Update Date | 07/11/2019
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Provider Practice Location Address
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Address Line | 2709 25TH AVENUE UNITS C&D
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City | GULFPORT
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State | MS
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Zip | 39501-4834
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Country | US
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Telephone | 228-357-5353
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Fax | 228-357-5354
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Provider Business Mailing Address
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Address Line | P.O. BOX 4445
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City | BILOXI
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State | MS
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Zip | 39535-4445
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Country | US
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Telephone | 228-207-0960
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Fax | 228-207-2787
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Authorized Official
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Title or Position | MANAGER/MEMBER
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Name | MS. NGA HOANG NGUYEN
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Credential | PHARM.D
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Telephone | 228-424-2086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 171891.1
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License Number State | MS
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