Provider Demographics
NPI:1699038190
Name:ZACHOW, KENNY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KENNY
Middle Name:
Last Name:ZACHOW
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 1:1304 N LIBERTY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-8523
Mailing Address - Country:US
Mailing Address - Phone:509-891-6967
Mailing Address - Fax:
Practice Address - Street 1:1304 N LIBERTY LAKE RD
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-8523
Practice Address - Country:US
Practice Address - Phone:509-891-6967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60236290183500000X
IDP6632183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist