Provider Demographics
NPI:1124660519
Name:MUNOZ MUNOZ, KENNEN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KENNEN
Middle Name:
Last Name:MUNOZ MUNOZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10912 COPPERLEFE DR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-2402
Mailing Address - Country:US
Mailing Address - Phone:941-201-8069
Mailing Address - Fax:
Practice Address - Street 1:5612 14TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-3609
Practice Address - Country:US
Practice Address - Phone:941-739-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS60066183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist