Provider Demographics
NPI:1710992334
Name:KENS PHARMACY INC
Entity Type:Organization
Organization Name:KENS PHARMACY INC
Other - Org Name:KENS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:KINH
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:504-254-8989
Mailing Address - Street 1:4626 ALCEE FORTIER BLVD
Mailing Address - Street 2:STE C
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70129-2130
Mailing Address - Country:US
Mailing Address - Phone:504-254-8989
Mailing Address - Fax:
Practice Address - Street 1:4626 ALCEE FORTIER BLVD
Practice Address - Street 2:STE C
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70129-2130
Practice Address - Country:US
Practice Address - Phone:504-254-8989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LA0027793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1261220Medicaid
2032906OtherPK