Provider Demographics
NPI:1861411571
Name:EILAND, KEN VON
Entity type:Individual
Prefix:MR
First Name:KEN
Middle Name:VON
Last Name:EILAND
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:KENTON
Other - Middle Name:VON
Other - Last Name:EILAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:327 REGENCY CIR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-4315
Mailing Address - Country:US
Mailing Address - Phone:478-274-5362
Mailing Address - Fax:303-398-5278
Practice Address - Street 1:2103 VETERANS BLVD
Practice Address - Street 2:UNIT 2
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-7502
Practice Address - Country:US
Practice Address - Phone:478-274-5362
Practice Address - Fax:303-398-5278
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16472183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy