Provider Demographics
NPI:1851311773
Name:KEH ENTERPRISES, INC
Entity Type:Organization
Organization Name:KEH ENTERPRISES, INC
Other - Org Name:MOREAU'S DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:E
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-589-7431
Mailing Address - Street 1:1312 HORRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70668-4532
Mailing Address - Country:US
Mailing Address - Phone:337-589-7431
Mailing Address - Fax:337-589-9995
Practice Address - Street 1:1312 HORRIDGE ST
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:LA
Practice Address - Zip Code:70668-4532
Practice Address - Country:US
Practice Address - Phone:337-589-7431
Practice Address - Fax:337-589-9995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3556-IR183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1264521Medicaid
1901114OtherNCPDP
LA1264521Medicaid