Provider Demographics
NPI:1922600121
Name:POWELL, KENNETH
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:POWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2226 POLIN RD
Mailing Address - Street 2:
Mailing Address - City:WILLISBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40078-8071
Mailing Address - Country:US
Mailing Address - Phone:502-349-6044
Mailing Address - Fax:502-349-6046
Practice Address - Street 1:3795 E JOHN ROWAN BLVD
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-3214
Practice Address - Country:US
Practice Address - Phone:502-349-6044
Practice Address - Fax:502-349-6046
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY08121183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist