Provider Demographics
NPI:1699830414
Name:WILLIAMS, KENNETH ALLAN (RPH)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:ALLAN
Last Name:WILLIAMS
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 1:7018 FOREST PARK DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46217-4123
Mailing Address - Country:US
Mailing Address - Phone:317-885-6891
Mailing Address - Fax:317-885-6891
Practice Address - Street 1:5730 CRAWFORDSVILLE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-3704
Practice Address - Country:US
Practice Address - Phone:317-241-6374
Practice Address - Fax:317-486-0353
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26013435A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist