=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710992334
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KENS PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2006
-----------------------------------------------------
Last Update Date | 04/17/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4626 ALCEE FORTIER BLVD STE C
-----------------------------------------------------
City | NEW ORLEANS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70129-2130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-254-8989
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4626 ALCEE FORTIER BLVD STE C
-----------------------------------------------------
City | NEW ORLEANS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70129-2130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-254-8989
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST IN CHARGE
-----------------------------------------------------
Name | KINH NGUYEN
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 504-254-8989
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 002779
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------