Provider Demographics
NPI:1659419562
Name:SCHWANDT, KENNETH F (BS,PHARM)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:F
Last Name:SCHWANDT
Suffix:
Gender:M
Credentials:BS,PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:13736 HWY 5
Mailing Address - City:CAVALIER
Mailing Address - State:ND
Mailing Address - Zip Code:58220-0339
Mailing Address - Country:US
Mailing Address - Phone:701-265-8555
Mailing Address - Fax:
Practice Address - Street 1:201 3 AVE S
Practice Address - Street 2:
Practice Address - City:CAVALIER
Practice Address - State:ND
Practice Address - Zip Code:58220-0249
Practice Address - Country:US
Practice Address - Phone:701-265-4744
Practice Address - Fax:701-265-4948
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3149183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist