Provider Demographics
NPI:1518451632
Name:PAY, KENNETH TIEA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:TIEA
Last Name:PAY
Suffix:
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 1:3055 LOUGHBOROUGH DR
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-1119
Mailing Address - Country:US
Mailing Address - Phone:209-384-1252
Mailing Address - Fax:
Practice Address - Street 1:3055 LOUGHBOROUGH DR
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-1119
Practice Address - Country:US
Practice Address - Phone:209-584-1252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78479183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist