Provider Demographics
NPI:1851691679
Name:FLETCHER, KENNETH B (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:B
Last Name:FLETCHER
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 1:2125 W US HIGHWAY 70
Mailing Address - Street 2:
Mailing Address - City:THATCHER
Mailing Address - State:AZ
Mailing Address - Zip Code:85552-5446
Mailing Address - Country:US
Mailing Address - Phone:928-428-7244
Mailing Address - Fax:928-428-7270
Practice Address - Street 1:5454 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-5319
Practice Address - Country:US
Practice Address - Phone:801-967-9185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018059183500000X
UT103318161701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist