Provider Demographics
NPI:1811233174
Name:KENGARD ENTERPRISES LLC
Entity Type:Organization
Organization Name:KENGARD ENTERPRISES LLC
Other - Org Name:KENT PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KENT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:641-203-1597
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:52361-0327
Mailing Address - Country:US
Mailing Address - Phone:641-203-1597
Mailing Address - Fax:319-626-6022
Practice Address - Street 1:1765 LININGER LN
Practice Address - Street 2:SUITE 300
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-2316
Practice Address - Country:US
Practice Address - Phone:319-626-6020
Practice Address - Fax:319-626-6022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies