Provider Demographics
NPI:1184450355
Name:HORNER, KENNETH FRANKLIN (PHARMD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:FRANKLIN
Last Name:HORNER
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 1:12032 247TH AVE
Mailing Address - Street 2:
Mailing Address - City:TREVOR
Mailing Address - State:WI
Mailing Address - Zip Code:53179-9219
Mailing Address - Country:US
Mailing Address - Phone:262-357-1811
Mailing Address - Fax:
Practice Address - Street 1:25401 75TH ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:WI
Practice Address - Zip Code:53168-9527
Practice Address - Country:US
Practice Address - Phone:262-843-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22791-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist