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General NPI Number Information
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NPI Number | 1164704219
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Entity Type | Individual
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Provider Name | KENNETH HOLDEN
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Gender | Male
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Dates
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Enumeration Date | 09/14/2011
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Last Update Date | 12/13/2013
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Provider Practice Location Address
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Address Line | 345 W RAILROAD AVE PAUL'S PHARMACY
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City | INDEPENDENCE
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State | LA
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Zip | 70443
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Country | US
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Telephone | 985-809-1515
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Fax |
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Provider Business Mailing Address
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Address Line | 18457 HIGHWAY 22
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City | PONCHATOULA
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State | LA
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Zip | 70454-6747
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Country | US
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Telephone | 985-974-2118
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Fax |
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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 | 10206
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License Number State | LA
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