Organization
IKENNA CORPORATION
Active
Other names
M J KELLY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
NWANMA IREGBULEM RPH (PIC)
(213) 622-5696
Entity
Organization
Contact information
Practice address
312 W 5TH ST STE 103, LOS ANGELES, CA 90013-1981
(213) 622-5696
(213) 622-5932
Mailing address
312 W 5TH ST, STE 103, LOS ANGELES, CA 90013-1900
(213) 622-5696
(213) 622-5932
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY47558
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2064879
PK
—
05
—
PHY348190
—
CA
Enumeration date
12/26/2006
Last updated
11/29/2016
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