Provider Demographics
NPI:1831799121
Name:KERNOHAN, DARBY WILLIAM (RPH)
Entity type:Individual
Prefix:MR
First Name:DARBY
Middle Name:WILLIAM
Last Name:KERNOHAN
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 1:850 NE 701 RD
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:MO
Mailing Address - Zip Code:65323-1608
Mailing Address - Country:US
Mailing Address - Phone:660-351-6100
Mailing Address - Fax:
Practice Address - Street 1:3201 W BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-2118
Practice Address - Country:US
Practice Address - Phone:660-826-2144
Practice Address - Fax:660-827-1906
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002018235183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist