Provider Demographics
NPI:1376850503
Name:ZIELINSKI, KENNETH JOHN (RPH)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:JOHN
Last Name:ZIELINSKI
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 1:15688 80TH DR N
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33418-1836
Mailing Address - Country:US
Mailing Address - Phone:561-758-9311
Mailing Address - Fax:866-238-9470
Practice Address - Street 1:10400 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5600
Practice Address - Country:US
Practice Address - Phone:561-758-9311
Practice Address - Fax:866-238-9470
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI411055183500000X
NE12249183500000X
LA17573183500000X
TN23610183500000X
ARPD10077183500000X
KY013156183500000X
ND5089183500000X
AZS017583183500000X
OH03329160183500000X
OR0012006183500000X
NV17808183500000X
FLPS26385183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist