MEDICARE: KENSTAR PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3637951	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023105228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENSTAR PHARMACY

Provider Business Mailing Address
First Line	:	3995 BROADWAY
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-2639
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3995 BROADWAY
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-2639
Country	:	US
Telephone Number	:	614-875-6933
Fax Number	:	614-875-6933

Authorized Official
Title or Position	:	OWNER/PHARM
Name	:	JAMES RICKET
Credential	:	RPH
Telephone Number	:	614-875-6933

Provider Enumeration Date	:	10/07/2006
Last Update Date	:	09/11/2025

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Directions to “KENSTAR PHARMACY ” Practice Location

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