Provider Demographics
NPI:1205957636
Name:KEN DRUGS, INC.
Entity type:Organization
Organization Name:KEN DRUGS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:O
Authorized Official - Last Name:SHOBOLA
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:813-426-5419
Mailing Address - Street 1:PO BOX 15779
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33684-5779
Mailing Address - Country:US
Mailing Address - Phone:813-348-0095
Mailing Address - Fax:813-872-6591
Practice Address - Street 1:4525 N PINE HILLS RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-1952
Practice Address - Country:US
Practice Address - Phone:407-425-2615
Practice Address - Fax:407-423-1648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH221163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy