Provider Demographics
NPI:1073138046
Name:PRICE, JOHN KENNETH MERCER (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:KENNETH MERCER
Last Name:PRICE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 LAKE SEYMOUR DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-4656
Mailing Address - Country:US
Mailing Address - Phone:570-955-9345
Mailing Address - Fax:
Practice Address - Street 1:5999 SUMMIT BRIDGE RD
Practice Address - Street 2:
Practice Address - City:TOWNSEND
Practice Address - State:DE
Practice Address - Zip Code:19734-9613
Practice Address - Country:US
Practice Address - Phone:302-696-1002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0005161183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist