Provider Demographics
NPI:1861523573
Name:BYKOWSKI, KENNETH JAMES (RPH)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:JAMES
Last Name:BYKOWSKI
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 1:5935 E KINGS AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-1318
Mailing Address - Country:US
Mailing Address - Phone:602-326-3088
Mailing Address - Fax:602-569-2787
Practice Address - Street 1:5935 E KINGS AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-1318
Practice Address - Country:US
Practice Address - Phone:602-326-3088
Practice Address - Fax:602-569-2787
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7975183500000X
IL051027819183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7975OtherARIZONA STATE BOARD OF PH
IL051027819OtherILLINOIS DEPARTMENT OF PROFESSIONAL REGULATION - PHARMACIST