Provider Demographics
NPI:1184938235
Name:WOHL, KENNETH EDWARD (RP)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:EDWARD
Last Name:WOHL
Suffix:
Gender:M
Credentials:RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 KINDERKAMACK RD
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-2216
Mailing Address - Country:US
Mailing Address - Phone:201-497-5505
Mailing Address - Fax:201-664-5963
Practice Address - Street 1:298 WESTWOOD AVE
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-1716
Practice Address - Country:US
Practice Address - Phone:201-664-0606
Practice Address - Fax:201-664-5963
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-31
Last Update Date:2010-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01882600183500000X
RIRPH03146183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist