Provider Demographics
NPI:1982789186
Name:GUESS, KENNETH SCOTT (PHARMD, MS PHAM,)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:SCOTT
Last Name:GUESS
Suffix:
Gender:M
Credentials:PHARMD, MS PHAM,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1673 CORAL DR
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-3433
Mailing Address - Country:US
Mailing Address - Phone:805-704-1934
Mailing Address - Fax:805-256-1475
Practice Address - Street 1:107 NELSON ST
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3318
Practice Address - Country:US
Practice Address - Phone:805-704-1934
Practice Address - Fax:805-256-1475
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100421835P0018X, 208VP0000X
CA37953183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAPH 10042OtherADVANCED PRACTICE PHARAMACIST
CA37953OtherPHARMACIST LICENSE