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General NPI Number Information
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NPI Number | 1689853095
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Entity Type | Organization
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Legal Business Name | KEVITHAN CORPORATION
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Dates
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Enumeration Date | 11/01/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2173 PICKWICK DR
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City | CAMARILLO
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State | CA
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Zip | 93010-6426
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Country | US
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Telephone | 805-389-5311
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Fax |
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Provider Business Mailing Address
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Address Line | 2173 PICKWICK DR
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City | CAMARILLO
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State | CA
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Zip | 93010-6426
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Country | US
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Telephone | 805-389-5311
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Fax |
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Authorized Official
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Title or Position | THIRD PARTY PLAN COORDINATOR
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Name | DENA FERMAN
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Credential |
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Telephone | 314-993-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY48914
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License Number State | CA
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