Ikenna Corporation

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY47558 Issued in CA

Legal business name

IKENNA CORPORATION

Doing business as

M J KELLY PHARMACY

Practice address

312 W 5TH St Ste 103
Los Angeles, CA 90013-1981

Phone

(213) 622-5696

Fax

(213) 622-5932

NPI assigned

Dec 26, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nwanma Iregbulem, RPH

Title

Pic

Phone

(213) 622-5696

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• M J KELLY PHARMACY Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480377600000",
    "number": "1730244153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 W 5TH ST",
            "address_2": "STE 103",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900131900",
            "telephone_number": "213-622-5696",
            "fax_number": "213-622-5932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 W 5TH ST STE 103",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900131981",
            "telephone_number": "213-622-5696",
            "fax_number": "213-622-5932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IKENNA CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-26",
        "last_updated": "2016-11-29",
        "status": "A",
        "authorized_official_last_name": "IREGBULEM",
        "authorized_official_first_name": "NWANMA",
        "authorized_official_title_or_position": "PIC",
        "authorized_official_telephone_number": "213-622-5696",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY47558",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2064879",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHY348190",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "M J KELLY PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Keiko Kay Ikeda, PH.D.
• Michelle M Ikeda, LMFT
• Yoko Ikeda
• Wayinbuife Oluwasemilore Ikejiora
• Kari Ikemoto, RD
• Ikigai Nutrition, Inc.
• Ikjae Acupuncture & Herbs Clinic Inc.
• Uchenna Hope Ikobi
• Michelle Ikoma, D.D.S.
• Shohei Ikoma, M.D.

• Community/Retail Pharmacy in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.