Provider Demographics
NPI:1679947683
Name:K & M DRUGS FORT MYERS LLC
Entity type:Organization
Organization Name:K & M DRUGS FORT MYERS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, AO
Authorized Official - Prefix:
Authorized Official - First Name:AYMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-301-6686
Mailing Address - Street 1:149 W HICKPOCHEE AVE
Mailing Address - Street 2:
Mailing Address - City:LABELLE
Mailing Address - State:FL
Mailing Address - Zip Code:33935-4753
Mailing Address - Country:US
Mailing Address - Phone:863-675-0004
Mailing Address - Fax:863-675-6048
Practice Address - Street 1:14651 PALM BEACH BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-2331
Practice Address - Country:US
Practice Address - Phone:239-689-5788
Practice Address - Fax:239-689-5822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-16
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH294123336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2155467OtherPK