Provider Demographics
NPI:1891556742
Name:KENANA, ISRAA ISMAIL (RPH)
Entity Type:Individual
Prefix:
First Name:ISRAA
Middle Name:ISMAIL
Last Name:KENANA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13051 OSBORNE ST APT 603
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-4015
Mailing Address - Country:US
Mailing Address - Phone:313-266-4562
Mailing Address - Fax:
Practice Address - Street 1:13051 OSBORNE ST APT 603
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-4015
Practice Address - Country:US
Practice Address - Phone:313-266-4562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302415733183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist