Provider Demographics
NPI:1588947873
Name:TRANTHAM, KENNETH DARREN (PD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:DARREN
Last Name:TRANTHAM
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-1715
Mailing Address - Country:US
Mailing Address - Phone:501-663-2142
Mailing Address - Fax:501-663-4415
Practice Address - Street 1:5525 W 12TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-1715
Practice Address - Country:US
Practice Address - Phone:501-663-2142
Practice Address - Fax:501-663-4415
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD7021183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist