Healthcare Provider Details

I. General information

NPI: 1326522467
Provider Name (Legal Business Name): KTN PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2018
Last Update Date: 04/02/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 WILLIAMS BLVD
KENNER LA
70062-6507
US

IV. Provider business mailing address

1301 WILLIAMS BLVD
KENNER LA
70062-6507
US

V. Phone/Fax

Practice location:
  • Phone: 504-905-9348
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KIM-PHUC NGUYEN
Title or Position: PHARMACIST/OWNER
Credential:
Phone: 504-468-2361