Provider Demographics
NPI:1952413866
Name:DT KENAI INVESTMENT LLC
Entity Type:Organization
Organization Name:DT KENAI INVESTMENT LLC
Other - Org Name:KANAB UNITED DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:REED
Authorized Official - Last Name:SHAKESPEARE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM-D
Authorized Official - Phone:435-644-2418
Mailing Address - Street 1:176 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:KANAB
Mailing Address - State:UT
Mailing Address - Zip Code:84741-3416
Mailing Address - Country:US
Mailing Address - Phone:435-644-2418
Mailing Address - Fax:435-644-2057
Practice Address - Street 1:176 W CENTER ST
Practice Address - Street 2:
Practice Address - City:KANAB
Practice Address - State:UT
Practice Address - Zip Code:84741-3416
Practice Address - Country:US
Practice Address - Phone:435-644-2418
Practice Address - Fax:435-644-2057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
UT942849317033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2131833OtherPK
UT=========001Medicaid
6721510001Medicare NSC