Provider Demographics
NPI:1083648067
Name:KENNIES MARKET INC
Entity Type:Organization
Organization Name:KENNIES MARKET INC
Other - Org Name:KENNIES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LEAD PHARMACIST/AO
Authorized Official - Prefix:
Authorized Official - First Name:MARION
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:717-359-4295
Mailing Address - Street 1:440 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17362-1122
Mailing Address - Country:US
Mailing Address - Phone:717-225-9382
Mailing Address - Fax:717-225-9362
Practice Address - Street 1:440 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRING GROVE
Practice Address - State:PA
Practice Address - Zip Code:17362-1122
Practice Address - Country:US
Practice Address - Phone:717-225-9382
Practice Address - Fax:717-225-9362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP415664L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2085038OtherPK
PA1007388500001Medicaid