Provider Demographics
NPI:1518023860
Name:ADAY, KENNETH WAYNE JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:WAYNE
Last Name:ADAY
Suffix:JR
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 1:2300 KATIE AVE
Mailing Address - Street 2:
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661-4766
Mailing Address - Country:US
Mailing Address - Phone:256-386-8209
Mailing Address - Fax:
Practice Address - Street 1:2800 HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35652-6046
Practice Address - Country:US
Practice Address - Phone:256-247-5833
Practice Address - Fax:256-247-5834
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14470183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100003750Medicaid