Kenneth Medley, D.C. RPH
Individual provider Active NPI Pharmacist · Deland, FL
NPI 1376877100 · NPPES record last updated Jan 31, 2013
Key facts
- NPI
- 1376877100
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PS0021792 (FL)
- Practice address
- 120 E New York Ave Ste D
Deland, FL 32724-5527 - Phone
- (386) 873-2990
- Fax
- (386) 873-2991
- NPI assigned
- Sep 26, 2009
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| CH9522 | FL | MD | Chiropractor |
| PS0021792 | FL | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | CH9522 | FL | |
| Pharmacist | 183500000X | PS0021792 | FL | Yes |
Addresses
Primary practice location
120 E New York Ave Ste D
Deland, FL 32724-5527
Mailing address
902 Lake Lindley Dr S
Deland, FL 32724-2565
Other providers in Deland, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 31, 2013. 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.