Kenneth Webster Fuqua Sr., RPH;CPH

Primary specialty

Ambulatory Care PharmacistTaxonomy code 1835P2201X

License

PS11329 Issued in FL

Practice address

1122 Old Polk City Rd
Lakeland, FL 33809-6622

Phone

(863) 858-2828

NPI assigned

Feb 10, 2017

Last updated

Feb 10, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1486684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486684800000",
    "number": "1174061048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1122 OLD POLK CITY RD",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338096622",
            "telephone_number": "863-858-2828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1122 OLD POLK CITY RD",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338096622",
            "telephone_number": "863-858-2828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUQUA",
        "first_name": "KENNETH",
        "middle_name": "WEBSTER",
        "name_suffix": "Sr.",
        "credential": "RPH;CPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-02-10",
        "last_updated": "2017-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835G0303X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Geriatric",
            "state": "FL",
            "license": "PU00102",
            "primary": false
        },
        {
            "code": "1835P2201X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Ambulatory Care",
            "state": "FL",
            "license": "PS11329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Care Pharmacist in Lakeland, FL
• Providers in Lakeland, FL by specialty
• Ambulatory Care Pharmacist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.