Provider Demographics
NPI:1760119820
Name:KENNISON PHARMACY, LLC
Entity Type:Organization
Organization Name:KENNISON PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KWARTENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-789-0048
Mailing Address - Street 1:1600 PINEHURST VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-7912
Mailing Address - Country:US
Mailing Address - Phone:404-789-0048
Mailing Address - Fax:678-288-9839
Practice Address - Street 1:4050 BUFORD DRIVE
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-3438
Practice Address - Country:US
Practice Address - Phone:678-288-9798
Practice Address - Fax:678-288-9839
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENNISON PHARMACY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-08
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy