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General NPI Number Information
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NPI Number | 1578086815
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Entity Type | Organization
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Legal Business Name | KC PHARMA LLC
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Dates
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Enumeration Date | 07/19/2017
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 37672 PROFESSIONAL CENTER DR STE 130B
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City | LIVONIA
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State | MI
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Zip | 48154-1140
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Country | US
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Telephone | 734-432-2015
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Fax | 734-432-2016
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Provider Business Mailing Address
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Address Line | 37672 PROFESSIONAL CENTER DR STE 130B
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City | LIVONIA
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State | MI
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Zip | 48154-1140
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Country | US
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Telephone | 734-432-2015
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. KHALIL CHAHINE
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Credential | PHARMD
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Telephone | 734-432-2015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 5301010939
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 5301010939
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License Number State | MI
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