Provider Demographics
NPI:1689730954
Name:MKA PHARMACY CORPORATION
Entity type:Organization
Organization Name:MKA PHARMACY CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:HOANG
Authorized Official - Last Name:DINH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:714-893-2697
Mailing Address - Street 1:14571 MAGNOLIA ST
Mailing Address - Street 2:STE 104
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5574
Mailing Address - Country:US
Mailing Address - Phone:714-893-2697
Mailing Address - Fax:714-893-3897
Practice Address - Street 1:14571 MAGNOLIA ST
Practice Address - Street 2:STE 104
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5574
Practice Address - Country:US
Practice Address - Phone:714-893-2697
Practice Address - Fax:714-893-3897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
CAPHY482983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5625011OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CAPHA482980Medicaid
5827420001Medicare NSC