MEDICARE: MR. KENNETH JOSEPH DENHARD

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	41622	CA

General Provider Information

NPI Number	:	1750655130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENNETH JOSEPH DENHARD

Provider Business Mailing Address
First Line	:	2923 YGNACIO VALLEY RD
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94598-3535
Country	:	US
Telephone Number	:	925-256-7230
Fax Number	:	925-256-7214

Provider Business Practice Location Address
First Line	:	2923 YGNACIO VALLEY RD
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94598-3535
Country	:	US
Telephone Number	:	925-256-7230
Fax Number	:	925-256-7214

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

Provider Enumeration Date	:	03/01/2012
Last Update Date	:	03/01/2012

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