Healthcare Provider Details

I. General information

NPI: 1801829221
Provider Name (Legal Business Name): KENLY DRUG & PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 05/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 E 2ND ST
KENLY NC
27542-7791
US

IV. Provider business mailing address

PO BOX 147
KENLY NC
27542-0147
US

V. Phone/Fax

Practice location:
  • Phone: 919-284-2333
  • Fax: 919-284-2717
Mailing address:
  • Phone: 919-284-2333
  • Fax:

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 Number08155
License Number StateNC

VIII. Authorized Official

Name: ROBIN DAVIS
Title or Position: OWNER
Credential: RPH
Phone: 919-284-2333