Provider Demographics
NPI:1841300993
Name:FUSSELL, KENNETH SCOTT (RPH)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:SCOTT
Last Name:FUSSELL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:76386 HIGHWAY 51
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:LA
Mailing Address - Zip Code:70444-3702
Mailing Address - Country:US
Mailing Address - Phone:985-230-0224
Mailing Address - Fax:985-748-6763
Practice Address - Street 1:804 W OAK ST
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422-2700
Practice Address - Country:US
Practice Address - Phone:985-748-6748
Practice Address - Fax:985-748-6763
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14343183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist