MEDICARE: KENNY D KWACK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	A1-0005020	DE
2	183500000X	Pharmacist	24597	MD

General Provider Information

NPI Number	:	1437601242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNY D KWACK

Provider Business Mailing Address
First Line	:	32979 COASTAL HWY
Second Line	:
City	:	BETHANY BEACH
State	:	DE
Zip	:	19930-3752
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	32979 COASTAL HWY
Second Line	:
City	:	BETHANY BEACH
State	:	DE
Zip	:	19930-3752
Country	:	US
Telephone Number	:	302-537-3700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2016
Last Update Date	:	12/06/2016

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Directions to “ KENNY D KWACK ” Practice Location

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