Provider Demographics
NPI:1619155884
Name:DROZD, KENNETH WALTER (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:WALTER
Last Name:DROZD
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 SALINA RD
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-4102
Mailing Address - Country:US
Mailing Address - Phone:856-589-7921
Mailing Address - Fax:
Practice Address - Street 1:2225 N 2ND ST
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-1305
Practice Address - Country:US
Practice Address - Phone:856-293-8177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-09
Last Update Date:2008-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01498600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI01498600OtherRPH STATE LICENSE NUMBER