Provider Demographics
NPI:1417177759
Name:KINSEY, KENBAH T (RPH)
Entity type:Individual
Prefix:
First Name:KENBAH
Middle Name:T
Last Name:KINSEY
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 1:300 SAN MATEO BLVD NE STE 902
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1507
Mailing Address - Country:US
Mailing Address - Phone:505-841-5871
Mailing Address - Fax:505-841-5885
Practice Address - Street 1:300 SAN MATEO BLVD NE STE 902
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1507
Practice Address - Country:US
Practice Address - Phone:505-841-5871
Practice Address - Fax:505-841-5885
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00003614183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist