Provider Demographics
NPI:1659668655
Name:KENNIES MARKET INC
Entity type:Organization
Organization Name:KENNIES MARKET INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LEAD PHARMACIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARION
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:717-359-4295
Mailing Address - Street 1:11 GRAND DR.
Mailing Address - Street 2:
Mailing Address - City:TANEYTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21787
Mailing Address - Country:US
Mailing Address - Phone:410-756-6166
Mailing Address - Fax:
Practice Address - Street 1:11 GRAND DR.
Practice Address - Street 2:
Practice Address - City:TANEYTOWN
Practice Address - State:MD
Practice Address - Zip Code:21787
Practice Address - Country:US
Practice Address - Phone:410-756-6166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-29
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP05541333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP05541OtherMARYLAND PHARMACY PERMIT
MD2135906OtherNCPDP IDENTIFIER
MD3931110003Medicare NSC