Provider Demographics
NPI:1639328529
Name:FUS, KENNETH P (RPH)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:P
Last Name:FUS
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 1:106 W. RACE STREET
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763
Mailing Address - Country:US
Mailing Address - Phone:865-376-5263
Mailing Address - Fax:865-376-3852
Practice Address - Street 1:106 W. RACE STREET
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:TN
Practice Address - Zip Code:37763
Practice Address - Country:US
Practice Address - Phone:865-376-5263
Practice Address - Fax:865-376-3852
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3603183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist