Organization
JAY KISHUN ENTERPRISE INC
Active
Other names
RIDGMAR PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
KAMLESHI KURANI (PIC)
(817) 737-7377
Entity
Organization
Contact information
Practice address
6823 GREEN OAKS RD STE C, FORT WORTH, TX 76116-1732
(817) 737-7377
(817) 737-7388
Mailing address
6823 GREEN OAKS RD STE C, FORT WORTH, TX 76116-1732
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
22047
TX
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145216
—
TX
01
—
4524193
OTHER ID NUMBER
—
Enumeration date
11/14/2007
Last updated
11/14/2007
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