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NPI Code Detail

MEDICARE: KENNETH LEE O'NEILL

MEDICARE: KENNETH LEE O'NEILL
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
1183500000XPharmacist9788-040WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
19788-040OTHERWIPHARMACIST

General Provider Information

NPI Number : 1487724001
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH LEE O'NEILL
Provider Business Mailing Address
First Line : 97 OAK CREEK TRL
Second Line :
City : MADISON
State : WI
Zip : 53717-1509
Country : US
Telephone Number : 608-263-9393
Fax Number :
Provider Business Practice Location Address
First Line : 2880 UNIVERSITY AVE
Second Line : MC 9001
City : MADISON
State : WI
Zip : 53705-3644
Country : US
Telephone Number : 608-263-9393
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2006
Last Update Date : 07/08/2007

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Directions to “ KENNETH LEE O'NEILL ” Practice Location

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