Provider Demographics
NPI:1780984989
Name:DANDURAND, KENNETH R (RPH)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:R
Last Name:DANDURAND
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-1647
Mailing Address - Country:US
Mailing Address - Phone:413-564-8100
Mailing Address - Fax:413-564-8101
Practice Address - Street 1:94 N ELM ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-1647
Practice Address - Country:US
Practice Address - Phone:413-564-8100
Practice Address - Fax:413-564-8101
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH171871835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist