Provider Demographics
NPI:1215105929
Name:SONICH, KENNETH WALTER (RPH)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:WALTER
Last Name:SONICH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 SHIRE LN
Mailing Address - Street 2:
Mailing Address - City:SWEDESBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-1477
Mailing Address - Country:US
Mailing Address - Phone:856-467-5737
Mailing Address - Fax:
Practice Address - Street 1:148 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-4100
Practice Address - Country:US
Practice Address - Phone:302-323-9612
Practice Address - Fax:302-323-9785
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0002187183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist