Provider Demographics
NPI:1679823942
Name:FICEK, KENNETH ANTHONY (RPH)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:ANTHONY
Last Name:FICEK
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 1:117 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4066
Mailing Address - Country:US
Mailing Address - Phone:701-223-0936
Mailing Address - Fax:701-224-0007
Practice Address - Street 1:117 N 5TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4066
Practice Address - Country:US
Practice Address - Phone:701-223-0936
Practice Address - Fax:701-224-0007
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDND3322183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist