Provider Demographics
NPI:1205422748
Name:FEARS, KENNETH LEE II (PHARMD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:LEE
Last Name:FEARS
Suffix:II
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 BILL TUCK HWY STE 1000
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-7159
Mailing Address - Country:US
Mailing Address - Phone:434-575-0078
Mailing Address - Fax:434-575-0252
Practice Address - Street 1:1020 BILL TUCK HWY STE 1000
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-7159
Practice Address - Country:US
Practice Address - Phone:434-575-0078
Practice Address - Fax:434-575-0252
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202211042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist