Provider Demographics
NPI:1740574854
Name:KILEY, KENNETH RICHARD JR (MS RPH)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:RICHARD
Last Name:KILEY
Suffix:JR
Gender:M
Credentials:MS RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 PENNY POND RD
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878-4726
Mailing Address - Country:US
Mailing Address - Phone:401-624-3354
Mailing Address - Fax:
Practice Address - Street 1:323 WILLIAM S CANNING BLVD
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-2339
Practice Address - Country:US
Practice Address - Phone:508-678-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15630183500000X
RI1956183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist