Healthcare Provider Details

I. General information

NPI: 1811921893
Provider Name (Legal Business Name): KENNIES MARKET INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 W KING ST
LITTLESTOWN PA
17340-1414
US

IV. Provider business mailing address

520 W KING ST
LITTLESTOWN PA
17340-1414
US

V. Phone/Fax

Practice location:
  • Phone: 717-359-9899
  • Fax: 717-359-9799
Mailing address:
  • Phone: 717-359-9899
  • Fax: 717-359-9799

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 NumberPP415708L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2085137
Identifier TypeOTHER
Identifier State
Identifier IssuerPK
# 2
Identifier1007388500003
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MARION LAMBERT
Title or Position: LEAD PHARMACIST/AO
Credential: RPH
Phone: 717-359-9899