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General NPI Number Information
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NPI Number | 1003897844
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Entity Type | Organization
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Legal Business Name | KENJURA PHARMACY , INC
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Dates
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Enumeration Date | 11/09/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 303 N PARK ST
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City | BRENHAM
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State | TX
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Zip | 77833-3146
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Country | US
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Telephone | 979-836-7922
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Fax | 979-836-1985
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Provider Business Mailing Address
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Address Line | 303 N PARK ST
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City | BRENHAM
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State | TX
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Zip | 77833-3146
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Country | US
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Telephone | 979-836-7922
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Fax | 979-836-1985
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Authorized Official
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Title or Position | OWNER
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Name | MR. ATWOOD C KENJURA
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Credential | RPH
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Telephone | 979-836-7922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 22629
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License Number State | TX
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