Provider Demographics
NPI:1376027300
Name:LOWE, KENNETH DWIGHT III (PHARMD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:DWIGHT
Last Name:LOWE
Suffix:III
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 1:460 N ARTHUR ST APT B205
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-6223
Mailing Address - Country:US
Mailing Address - Phone:812-319-3461
Mailing Address - Fax:
Practice Address - Street 1:1901 N STEPTOE ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7120
Practice Address - Country:US
Practice Address - Phone:509-783-3413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-15
Last Update Date:2018-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60862050183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH60862050OtherPHARMACIST LICENSE