NPIMap

Organization Active NPI

Kak Healthcare, LLC

Doing business as Pharm House Drug- Trinity LLC

  • Community/Retail Pharmacy
  • Trinity, TX
National Provider Identifier
1497254544
Registry record updated Sep 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
KAK HEALTHCARE, LLC
Doing business as
Pharm House Drug- Trinity LLC
Practice address
485 S Robb St.
Ste B
Trinity, TX 75862
Phone
(936) 594-3593
Fax
(936) 594-9681
NPI assigned
Feb 5, 2018
Last updated
Sep 21, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
KAK HEALTH HOLDINGS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kristi Ann Kubosh, PHARMDNPI 1508403973
Title
Owner
Phone
(797) 218-4735

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 31762 TX
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

485 S Robb St.
Ste B
Trinity, TX 75862

Mailing address

4941 Reiger Ave
Dallas, TX 75214
Phone (979) 218-4735

Other identifiers 2

IdentifierTypeStateIssuer
149789MedicaidTX
2175858OtherPK

Other names 1

  • Pharm House Drug- Trinity LLC Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1517788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663718400000",
    "number": "1497254544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4941 REIGER AVE",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "75214",
            "telephone_number": "979-218-4735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "485 S ROBB ST.",
            "address_2": "STE B",
            "city": "TRINITY",
            "state": "TX",
            "postal_code": "75862",
            "telephone_number": "936-594-3593",
            "fax_number": "936-594-9681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAK HEALTHCARE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KAK HEALTH HOLDINGS, LLC",
        "enumeration_date": "2018-02-05",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-21",
        "status": "A",
        "authorized_official_last_name": "KUBOSH",
        "authorized_official_first_name": "KRISTI",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "797-218-4735",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "31762",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149789",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2175858",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pharm House Drug- Trinity LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Trinity, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.