Provider Demographics
NPI:1942581186
Name:MONROE, KENNETH PATRICK (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:PATRICK
Last Name:MONROE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 BI LO BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5346
Mailing Address - Country:US
Mailing Address - Phone:864-213-2583
Mailing Address - Fax:864-213-2503
Practice Address - Street 1:208 BI LO BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5346
Practice Address - Country:US
Practice Address - Phone:864-213-2583
Practice Address - Fax:864-213-2503
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9999183500000X
NC10729183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist