Provider Demographics
NPI:1538383500
Name:MCELHOSE, KENNETH RAY
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:RAY
Last Name:MCELHOSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5304 VENTURA DRIVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-9778
Mailing Address - Country:US
Mailing Address - Phone:402-721-2108
Mailing Address - Fax:402-721-2288
Practice Address - Street 1:1900 E MILITARY
Practice Address - Street 2:MILLER PHARMACY INC
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-5494
Practice Address - Country:US
Practice Address - Phone:402-721-1100
Practice Address - Fax:402-721-0861
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7744183500000X
NM6939183500000X
IDP6057183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist