Provider Demographics
NPI:1275692063
Name:PM KENNEMUR ENTERPRISES INC
Entity Type:Organization
Organization Name:PM KENNEMUR ENTERPRISES INC
Other - Org Name:MEDICINE CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:KENNEMUR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:432-263-7316
Mailing Address - Street 1:1009 S GREGG ST
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-2919
Mailing Address - Country:US
Mailing Address - Phone:432-263-7316
Mailing Address - Fax:432-264-7035
Practice Address - Street 1:1009 S GREGG ST
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-2919
Practice Address - Country:US
Practice Address - Phone:432-263-7316
Practice Address - Fax:432-264-7035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25332332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5849920001Medicaid