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General NPI Number Information
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NPI Number | 1396038501
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Entity Type | Organization
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Legal Business Name | KISKEYA INVESTMENT GROUP LLC
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Dates
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Enumeration Date | 05/20/2011
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Last Update Date | 05/25/2011
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Provider Practice Location Address
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Address Line | 1203 E SUNRISE BLVD
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-2810
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Country | US
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Telephone | 954-766-6007
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Fax | 954-766-6037
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Provider Business Mailing Address
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Address Line | 3880 W BROWARD BLVD STE 7
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City | FORT LAUDERDALE
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State | FL
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Zip | 33312-1058
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Country | US
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Telephone | 954-990-4217
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Fax | 954-990-4263
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Authorized Official
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Title or Position | PIC
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Name | PRICE JEAN-GILLES
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Credential |
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Telephone | 954-632-0601
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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 | PH25475
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License Number State | FL
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