Provider Demographics
NPI:1891078531
Name:TO, KENNETH M (R PH)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:M
Last Name:TO
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8350 BRIOVA DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2257
Mailing Address - Country:US
Mailing Address - Phone:855-427-4682
Mailing Address - Fax:877-342-4596
Practice Address - Street 1:8350 BRIOVA DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-2257
Practice Address - Country:US
Practice Address - Phone:855-427-4682
Practice Address - Fax:877-432-4596
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2019-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15166183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist