Provider Demographics
NPI:1841594389
Name:HOOVEN, KENYON BRENT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KENYON
Middle Name:BRENT
Last Name:HOOVEN
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 1:60 MICHELLE LN
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-8290
Mailing Address - Country:US
Mailing Address - Phone:540-992-5158
Mailing Address - Fax:
Practice Address - Street 1:72 KINGSTON DR
Practice Address - Street 2:
Practice Address - City:DALEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24083-2574
Practice Address - Country:US
Practice Address - Phone:540-992-1291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-24
Last Update Date:2010-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206638183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist