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General NPI Number Information
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NPI Number | 1063639847
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Entity Type | Individual
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Provider Name | KENNETH JAMES DUMAS R.PH
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Gender | Male
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7201 W 24TH ST
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City | NORTH RIVERSIDE
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State | IL
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Zip | 60546-1591
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Country | US
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Telephone | 847-370-2577
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Fax |
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Provider Business Mailing Address
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Address Line | 1529 S STATE ST APT. 17-J
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City | CHICAGO
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State | IL
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Zip | 60605-3011
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Country | US
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Telephone | 312-913-0253
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Fax | 847-916-4129
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 3146
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 23985
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number |
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number |
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License Number State | VT
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