Organization
KEVITHAN CORPORATION
Active
Other names
MEDICINE SHOPPE
Organization subpart
No
Provider details
NPI number
Authorized official
DENA FERMAN (THIRD PARTY PLAN COORDINATOR)
(314) 993-6000
Entity
Organization
Contact information
Practice address
2173 PICKWICK DR, CAMARILLO, CA 93010-6426
(805) 389-5311
Mailing address
2173 PICKWICK DR, CAMARILLO, CA 93010-6426
(805) 389-5311
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY48914
CA
3336C0003X
Community/Retail Pharmacy
—
CA
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5628788
NCPDP
CA
Enumeration date
11/01/2007
Last updated
03/07/2023
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