Kennesaw RX LLC

Primary specialty

PharmacyTaxonomy code 333600000X

License

PHRE010626 Issued in GA

Legal business name

KENNESAW RX LLC

Doing business as

Kennesaw Pharmacy

Practice address

2851 Cobb Pkwy NW Ste 107
Kennesaw, GA 30152-2718

Phone

(700) 800-0025

Fax

(770) 800-0325

NPI assigned

May 22, 2018

Organization subpart

No

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

Authorized official

Name

Ritesh PatelNPI 1457668907

Title

Pharmacy Manager

Phone

(770) 800-0025

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Kennesaw Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in GA2 enrollments

Enrollment records 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ritesh Patel, PHARMD

  • Pharmacist
  • Kennesaw, GA
  • NPI 1457668907
  NPD Authorized official

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

{
    "created_epoch": "1526947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573516800000",
    "number": "1992296339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2851 COBB PKWY NW STE 107",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301522718",
            "telephone_number": "770-800-0025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2851 COBB PKWY NW STE 107",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301522718",
            "telephone_number": "700-800-0025",
            "fax_number": "770-800-0325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNESAW RX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-22",
        "last_updated": "2019-11-12",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "RITESH",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "770-800-0025"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "GA",
            "license": "PHRE010626",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2177779",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kennesaw Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kennesaw Modern Dentistry, PC
• Kennesaw Mountain Dental Associates
• Kennesaw Mountain Medical Group
• Kennesaw Pediatric Dentistry
• Kennesaw Pediatrics
• Kennesaw State University
• Kennesaw State University Health Clinic
• Kennesaw Trauma and Addiction Center
• Kennesaw Wellness
• Kennesaw West Chiro and Rehab

• Pharmacy in Kennesaw, GA
• Providers in Kennesaw, GA by specialty
• Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.