Provider Demographics
NPI:1942899653
Name:JAMES, KENNETH BRIAN (PHARMD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:BRIAN
Last Name:JAMES
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 1:18525 LIME CIR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6619
Mailing Address - Country:US
Mailing Address - Phone:714-454-8291
Mailing Address - Fax:
Practice Address - Street 1:18525 LIME CIR
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6619
Practice Address - Country:US
Practice Address - Phone:714-454-8291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-16
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38993183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist