Healthcare Provider Details

I. General information

NPI: 1235883364
Provider Name (Legal Business Name): KENZIE CO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 CARMEL AVE NE STE 303B
ALBUQUERQUE NM
87122-3125
US

IV. Provider business mailing address

12430 MAGIC MIST RD NE
ALBUQUERQUE NM
87122-1284
US

V. Phone/Fax

Practice location:
  • Phone: 505-417-7196
  • Fax:
Mailing address:
  • Phone: 505-417-7196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER ORTEGA
Title or Position: CEO
Credential: PHARMD
Phone: 505-417-7196