Provider Demographics
NPI:1831302777
Name:KUCHAY, KENNETH STANLEY (RPH)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:STANLEY
Last Name:KUCHAY
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 1:7804 166TH ST
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-2414
Mailing Address - Country:US
Mailing Address - Phone:708-633-9895
Mailing Address - Fax:708-633-1631
Practice Address - Street 1:5610 159TH ST
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-3104
Practice Address - Country:US
Practice Address - Phone:708-687-0126
Practice Address - Fax:708-687-7853
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist