Provider Demographics
NPI:1215229810
Name:DILLEY, KENNETH GAIL (RPH)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:GAIL
Last Name:DILLEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:886 RITTER DR
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:WV
Mailing Address - Zip Code:25813-9513
Mailing Address - Country:US
Mailing Address - Phone:304-256-0412
Mailing Address - Fax:304-256-0418
Practice Address - Street 1:886 RITTER DR
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:WV
Practice Address - Zip Code:25813-9513
Practice Address - Country:US
Practice Address - Phone:304-256-0412
Practice Address - Fax:304-256-0418
Is Sole Proprietor?:No
Enumeration Date:2011-05-14
Last Update Date:2011-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0004461183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist