Organization
KYRIELYNN LLC
Active
Other names
Carson's Northridge Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
GURJOT JOTI CARSON (PHARMACY OWNWR)
(937) 926-2002
Entity
Organization
Contact information
Practice address
4923 SECURITY DR, SPRINGFIELD, OH 45503-5651
(937) 504-7700
(937) 504-7311
Mailing address
4923 SECURITY DR, SPRINGFIELD, OH 45503-5651
(937) 504-7700
(937) 504-7311
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
022717200
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2168744
PK
—
Enumeration date
04/18/2017
Last updated
05/01/2017
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