Provider Demographics
NPI:1558643130
Name:KRAMER, KENNETH RICHARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:RICHARD
Last Name:KRAMER
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 1:356 12TH ST SW
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-1749
Mailing Address - Country:US
Mailing Address - Phone:651-464-1994
Mailing Address - Fax:651-464-1994
Practice Address - Street 1:356 12TH ST SW
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-1749
Practice Address - Country:US
Practice Address - Phone:651-464-1994
Practice Address - Fax:651-464-1994
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN112353183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist