Provider Demographics
NPI:1619299427
Name:SENELORM, KENNETH DELA (PHARMD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:DELA
Last Name:SENELORM
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 1:18 METROPOLITAN OVAL APT 5D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-6791
Mailing Address - Country:US
Mailing Address - Phone:718-239-5440
Mailing Address - Fax:
Practice Address - Street 1:2504 EASTCHESTER RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5902
Practice Address - Country:US
Practice Address - Phone:718-881-1578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-20
Last Update Date:2010-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI053052183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist