Provider Demographics
NPI:1609976273
Name:BERRY, KENNETH EARL (PHARM D, RPH)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:EARL
Last Name:BERRY
Suffix:
Gender:M
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3256 W MOONDANCE WAY
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-1249
Mailing Address - Country:US
Mailing Address - Phone:520-742-6004
Mailing Address - Fax:
Practice Address - Street 1:3256 W MOONDANCE WAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-1249
Practice Address - Country:US
Practice Address - Phone:520-742-6004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ110061835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy