Provider Demographics
NPI:1144239815
Name:SOSEBEE, KENNETH LEN (RPH)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:LEN
Last Name:SOSEBEE
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 1:1104 MESA VERDE DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712
Mailing Address - Country:US
Mailing Address - Phone:254-420-2351
Mailing Address - Fax:
Practice Address - Street 1:4800 MEMORIAL DR
Practice Address - Street 2:DEPT 119
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76711
Practice Address - Country:US
Practice Address - Phone:254-297-3238
Practice Address - Fax:254-297-5178
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist