Provider Demographics
NPI:1174821227
Name:MCKNEELY, KENNETH H SR
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:H
Last Name:MCKNEELY
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7212 CATTAIL CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-2503
Mailing Address - Country:US
Mailing Address - Phone:540-845-7212
Mailing Address - Fax:540-785-6671
Practice Address - Street 1:11129 GORDON RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-1714
Practice Address - Country:US
Practice Address - Phone:540-785-6634
Practice Address - Fax:540-785-6671
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202004426183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist