Provider Demographics
NPI:1093310922
Name:ANNEAR, KENNETH MORAN (R PH)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:MORAN
Last Name:ANNEAR
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-2347
Mailing Address - Country:US
Mailing Address - Phone:972-333-5241
Mailing Address - Fax:
Practice Address - Street 1:605 W ENNIS AVE
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-3805
Practice Address - Country:US
Practice Address - Phone:972-875-4821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23931183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist