Provider Demographics
NPI:1760576177
Name:KEVREN INC
Entity Type:Organization
Organization Name:KEVREN INC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:513-424-8180
Mailing Address - Street 1:1971 CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044
Mailing Address - Country:US
Mailing Address - Phone:513-424-8180
Mailing Address - Fax:513-424-6672
Practice Address - Street 1:1971 CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044
Practice Address - Country:US
Practice Address - Phone:513-424-8180
Practice Address - Fax:513-424-6672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020440800333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0808462Medicaid
OH0608462Medicaid
3644780OtherOTHER ID NUMBER-COMMERCIAL NUMBER
3644780OtherOTHER ID NUMBER-COMMERCIAL NUMBER
OH0808462Medicaid
OHFV93121Medicare PIN