Provider Demographics
NPI:1235883364
Name:KENZIE CO DBA SOUTHWEST VACCINATION AND CONSULTING SERVICES
Entity Type:Organization
Organization Name:KENZIE CO DBA SOUTHWEST VACCINATION AND CONSULTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:505-417-7196
Mailing Address - Street 1:12430 MAGIC MIST RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-1284
Mailing Address - Country:US
Mailing Address - Phone:505-417-7196
Mailing Address - Fax:
Practice Address - Street 1:5411 JEFFERSON ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3473
Practice Address - Country:US
Practice Address - Phone:505-417-7196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy