=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598520025
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GKH INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2024
-----------------------------------------------------
Last Update Date | 02/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3610 N MAJOR DR
-----------------------------------------------------
City | BEAUMONT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77713-9573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-860-0040
-----------------------------------------------------
Fax | 409-860-0046
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3610 N MAJOR DR
-----------------------------------------------------
City | BEAUMONT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77713-9573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-860-0040
-----------------------------------------------------
Fax | 409-860-0046
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | BRENDA GUIDRY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 409-860-0040
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------