Provider Demographics
NPI:1528512563
Name:ALLEN, KENNETH III (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:ALLEN
Suffix:III
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 1:2667 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-3875
Mailing Address - Country:US
Mailing Address - Phone:502-551-1292
Mailing Address - Fax:
Practice Address - Street 1:2667 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-3875
Practice Address - Country:US
Practice Address - Phone:502-551-1292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0166791835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy