Provider Demographics
NPI:1437571825
Name:LETCHWORTH, KENNETH ALBERT (RPH)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:ALBERT
Last Name:LETCHWORTH
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 1:3012 E BRITTINGTON
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-8701
Mailing Address - Country:US
Mailing Address - Phone:757-229-5377
Mailing Address - Fax:
Practice Address - Street 1:3012 E BRITTINGTON
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-8701
Practice Address - Country:US
Practice Address - Phone:757-229-5377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-20
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202006061183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist