Provider Demographics
NPI:1952423378
Name:GEORGE, KENNETH DONALD (R PH)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:DONALD
Last Name:GEORGE
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 COUNTY ROAD 449
Mailing Address - Street 2:
Mailing Address - City:CENTRE
Mailing Address - State:AL
Mailing Address - Zip Code:35960-6828
Mailing Address - Country:US
Mailing Address - Phone:256-927-5427
Mailing Address - Fax:256-927-8588
Practice Address - Street 1:1490 CHESNUT BYP
Practice Address - Street 2:
Practice Address - City:CENTRE
Practice Address - State:AL
Practice Address - Zip Code:35960-2815
Practice Address - Country:US
Practice Address - Phone:256-927-8539
Practice Address - Fax:256-927-8588
Is Sole Proprietor?:No
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7048183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist