Organization
GKA INC
Active
Other names
Pro Health Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
GRIGORIY KANDKHOROV (PHARMACIST)
(718) 507-7775
Entity
Organization
Contact information
Practice address
8412 37TH AVE, JACKSON HEIGHTS, NY 11372-7339
(718) 507-7775
(718) 507-7781
Mailing address
8412 37TH AVE, JACKSON HEIGHTS, NY 11372-7339
(718) 507-7775
(718) 507-7781
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
030629
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5802485
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/11/2011
Last updated
05/26/2011
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