Provider Demographics
NPI:1467851857
Name:ELKENANI, ISLAM (RPH)
Entity Type:Individual
Prefix:
First Name:ISLAM
Middle Name:
Last Name:ELKENANI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1128 GAIL CT APT 45
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-6057
Mailing Address - Country:US
Mailing Address - Phone:502-224-2222
Mailing Address - Fax:
Practice Address - Street 1:402 2ND ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-3221
Practice Address - Country:US
Practice Address - Phone:502-224-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY017276183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist