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General NPI Number Information
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NPI Number | 1235215542
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Entity Type | Organization
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Legal Business Name | KMDS INC
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Dates
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Enumeration Date | 10/29/2006
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Last Update Date | 10/18/2007
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Provider Practice Location Address
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Address Line | 3250 3RD AVE
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City | BRONX
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State | NY
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Zip | 10456-6743
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Country | US
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Telephone | 718-842-0031
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Fax | 718-842-0129
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Provider Business Mailing Address
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Address Line | 3250 3RD AVE
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City | BRONX
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State | NY
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Zip | 10456-6743
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Country | US
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Telephone | 718-842-0031
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Fax | 718-842-0129
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Authorized Official
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Title or Position | SUPERVISING PHARMACIST
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Name | MR. SUDARSANA VARMA UDDARAJU
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Credential | B.S.
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Telephone | 718-842-0031
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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 | 025129
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License Number State | NY
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