Provider Demographics
NPI:1992712038
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:
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 1:4730 N HABANA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7163
Practice Address - Country:US
Practice Address - Phone:813-348-0095
Practice Address - Fax:813-872-6591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBK82118773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1098361OtherNCPDP