Provider Demographics
NPI:1538522446
Name:KINETIX GROUP LLC
Entity type:Organization
Organization Name:KINETIX GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SARTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-983-1239
Mailing Address - Street 1:104 BUSINESS PARK DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-6017
Mailing Address - Country:US
Mailing Address - Phone:662-803-2094
Mailing Address - Fax:601-326-7377
Practice Address - Street 1:104 BUSINESS PARK DR STE H
Practice Address - Street 2:SUITE H
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-6017
Practice Address - Country:US
Practice Address - Phone:662-803-2094
Practice Address - Fax:601-326-7377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 3336C0003X, 3336S0011X
MS14764/1.1333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159399OtherPK