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| Type | Company | [sources] | |||
|---|---|---|---|---|---|
| Name | Kenneth Road Pharmacy, Inc. | [sources] | |||
| Incorporation date | not available | [sources] | |||
| Jurisdiction | not available | [sources] | |||
| Country | United States of America | [sources] | |||
| NPI | 1144365776 | [sources] | |||
| Registration number | PH0A94460 · PHY 50214 | [sources] | |||
| Sector | Pharmacy/Pharmacist | [sources] | |||
| Address | 1400 West Kenneth Rd., Glendale, CA, 91201-1496 | [sources] | |||
| Last change | Last processed | First seen | |||
Medical providers suspended from or otherwise deemed ineligible to participate in California's Medicaid program.
United States of America · DHCS
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