Provider Demographics
NPI:1588417208
Name:DATO, KENNETH EDWARD A (PHARMD)
Entity type:Individual
Prefix:
First Name:KENNETH EDWARD
Middle Name:A
Last Name:DATO
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 1:9109 REDWATER DR
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-5448
Mailing Address - Country:US
Mailing Address - Phone:916-622-6339
Mailing Address - Fax:
Practice Address - Street 1:10451 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-1987
Practice Address - Country:US
Practice Address - Phone:916-780-2898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89346183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist