Provider Demographics
NPI:1659976645
Name:CARMAN, OIWAKENIX LAI
Entity Type:Individual
Prefix:
First Name:OIWAKENIX
Middle Name:LAI
Last Name:CARMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KENIX
Other - Middle Name:
Other - Last Name:CARMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:709 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-2407
Mailing Address - Country:US
Mailing Address - Phone:502-226-7049
Mailing Address - Fax:
Practice Address - Street 1:709 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-2407
Practice Address - Country:US
Practice Address - Phone:502-226-7049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP063953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY015419OtherKYBOP LICENSE