Provider Demographics
NPI:1952073553
Name:BISCH, KENNETH (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:BISCH
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 BROOKSIDE CT APT 907
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-7117
Mailing Address - Country:US
Mailing Address - Phone:203-586-9905
Mailing Address - Fax:
Practice Address - Street 1:1475 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-1914
Practice Address - Country:US
Practice Address - Phone:860-423-6304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0015720183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist