Provider Demographics
NPI:1538322532
Name:KENI PHARMACY INC
Entity Type:Organization
Organization Name:KENI PHARMACY INC
Other - Org Name:KENI PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LLANES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-228-4980
Mailing Address - Street 1:13911 SW 42ND ST
Mailing Address - Street 2:STE 203
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13911 SW 42ND ST
Practice Address - Street 2:STE 203
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6403
Practice Address - Country:US
Practice Address - Phone:305-228-4980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH234293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1036107OtherNCPDP PROVIDER IDENTIFICATION NUMBER
6132220001Medicare NSC