Healthcare Provider Details

I. General information

NPI: 1700980760
Provider Name (Legal Business Name): KENCO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 W MAUMEE ST
ADRIAN MI
49221-1805
US

IV. Provider business mailing address

1821 SPRING ARBOR RD
JACKSON MI
49203-2703
US

V. Phone/Fax

Practice location:
  • Phone: 517-265-9162
  • Fax: 517-266-1455
Mailing address:
  • Phone: 517-787-6081
  • Fax: 517-787-0160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301007786
License Number StateMI

VIII. Authorized Official

Name: GRANT BROWN
Title or Position: DIR OF PHARMACY OPERATIONS
Credential: PHARM.D.
Phone: 517-789-8980