Provider Demographics
NPI:1689609695
Name:TSE, KENNETH KWONG (RPH)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:KWONG
Last Name:TSE
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 1:9030 KIMBERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-2823
Mailing Address - Country:US
Mailing Address - Phone:561-470-5897
Mailing Address - Fax:561-482-5464
Practice Address - Street 1:9030 KIMBERLY BLVD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-2823
Practice Address - Country:US
Practice Address - Phone:561-470-5897
Practice Address - Fax:561-482-5464
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 36414183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist