Healthcare Provider Details

I. General information

NPI: 1083648067
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

440 N MAIN ST
SPRING GROVE PA
17362-1122
US

IV. Provider business mailing address

440 N MAIN ST
SPRING GROVE PA
17362-1122
US

V. Phone/Fax

Practice location:
  • Phone: 717-225-9382
  • Fax: 717-225-9362
Mailing address:
  • Phone: 717-225-9382
  • Fax: 717-225-9362

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 NumberPP415664L
License Number StatePA

VIII. Authorized Official

Name: MARION LAMBERT
Title or Position: LEAD PHARMACIST/AO
Credential: RPH
Phone: 717-359-4295