Provider Demographics
NPI:1073899050
Name:WEDSTED, KENNETH RAY (PHARMD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:RAY
Last Name:WEDSTED
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 1:428 JAPONICA LN
Mailing Address - Street 2:HOT SPRINGS
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-9527
Mailing Address - Country:US
Mailing Address - Phone:501-760-2089
Mailing Address - Fax:501-760-2435
Practice Address - Street 1:1800 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-5396
Practice Address - Country:US
Practice Address - Phone:501-760-2089
Practice Address - Fax:501-760-2435
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-22
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD08801183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist