Kenneth E Prewett, RPH
Individual provider Active NPI Pharmacist · Pontotoc, MS
NPI 1376852525 · NPPES record last updated Oct 5, 2010
Key facts
- NPI
- 1376852525
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- E5820 (MS)
- Practice address
- 170 Highway 15 N
Pontotoc, MS 38863 - Phone
- (662) 489-4721
- Fax
- (662) 489-0335
- NPI assigned
- Oct 5, 2010
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E5820 | MS | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Freds Stores of Tennessee Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | E5820 | MS | Yes |
Addresses
Primary practice location
170 Highway 15 N
Pontotoc, MS 38863
Mailing address
P. O. Box 824
Pontotoc, MS 38863
Phone (662) 489-4721
Other providers in Pontotoc, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 5, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.