MEDICARE: KENBAH T KINSEY RPH

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	183500000X	Pharmacist	RP00003614	NM

General Provider Information

NPI Number	:	1417177759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENBAH T KINSEY RPH

Provider Business Mailing Address
First Line	:	300 SAN MATEO BLVD NE STE 902
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-1507
Country	:	US
Telephone Number	:	505-841-5871
Fax Number	:	505-841-5885

Provider Business Practice Location Address
First Line	:	300 SAN MATEO BLVD NE STE 902
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-1507
Country	:	US
Telephone Number	:	505-841-5871
Fax Number	:	505-841-5885

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2007
Last Update Date	:	07/08/2007

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