Provider Demographics
NPI:1386927457
Name:ROBINSON, KENNETH R (PHARM D)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:R
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 CLYBOURN CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-4149
Mailing Address - Country:US
Mailing Address - Phone:435-699-1928
Mailing Address - Fax:
Practice Address - Street 1:124 CLYBOURN CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-4149
Practice Address - Country:US
Practice Address - Phone:435-699-1928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-24
Last Update Date:2011-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV18100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist