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General NPI Number Information
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NPI Number | 1629696331
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Entity Type | Individual
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Provider Name | KENNETH JAMES MYERS PHARMD
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Gender | Male
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Dates
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Enumeration Date | 07/09/2020
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Last Update Date | 07/09/2020
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Provider Practice Location Address
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Address Line | 4214 E INDIAN SCHOOL RD STE 103
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City | PHOENIX
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State | AZ
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Zip | 85018-5339
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Country | US
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Telephone | 602-899-6960
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Fax |
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Provider Business Mailing Address
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Address Line | 4824 E WILLIAMS DR
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City | PHOENIX
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State | AZ
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Zip | 85054-6175
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Country | US
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Telephone | 602-769-9521
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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 | S024669
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License Number State | AZ
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