Provider Demographics
NPI:1356619902
Name:SPEIDEL, KENNETH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:SPEIDEL
Suffix:
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 1:232 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-2110
Mailing Address - Country:US
Mailing Address - Phone:330-633-0714
Mailing Address - Fax:
Practice Address - Street 1:232 WEST AVE
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2110
Practice Address - Country:US
Practice Address - Phone:330-633-0714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-11
Last Update Date:2011-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH033143511835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy