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NPI Code Detail

MEDICARE: KACI BOULWARE KENON PHARMD

MEDICARE: KACI BOULWARE KENON PHARMD
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
1183500000XPharmacistRPH020323GA

General Provider Information

NPI Number : 1508148891
Entity Type Code : Individual
Provider Name (Legal Business Name) : KACI BOULWARE KENON PHARMD
Provider Business Mailing Address
First Line : 1124 WILLOW CREST WAY
Second Line :
City : AUSTELL
State : GA
Zip : 30168-5734
Country : US
Telephone Number : 305-528-0270
Fax Number :
Provider Business Practice Location Address
First Line : 3155 ROYAL DR
Second Line :
City : ALPHARETTA
State : GA
Zip : 30022-2475
Country : US
Telephone Number : 678-715-2578
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2011
Last Update Date : 05/29/2026

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Directions to “ KACI BOULWARE KENON PHARMD” Practice Location

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