Provider Demographics
NPI:1720415953
Name:MORIN, KENNETH G (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:G
Last Name:MORIN
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 1:4810 GALLERIA PKWY
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-9605
Mailing Address - Country:US
Mailing Address - Phone:775-356-4409
Mailing Address - Fax:
Practice Address - Street 1:4810 GALLERIA PKWY
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-9605
Practice Address - Country:US
Practice Address - Phone:775-356-4409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55302183500000X
NV161131835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist