Healthcare Provider Details

I. General information

NPI: 1942800792
Provider Name (Legal Business Name): KENNA B STARNES RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2020
Last Update Date: 10/30/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3921 BENBROOK HWY
FORT WORTH TX
76116-7895
US

IV. Provider business mailing address

3921 BENBROOK HWY
FORT WORTH TX
76116-7895
US

V. Phone/Fax

Practice location:
  • Phone: 817-738-2135
  • Fax: 817-763-8784
Mailing address:
  • Phone: 817-738-2135
  • Fax: 817-763-8784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26333
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: