Individual
KENNETH WEBSTER FUQUA SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH;CPH
Contact information
Practice address
1122 OLD POLK CITY RD, LAKELAND, FL 33809-6622
(863) 858-2828
Mailing address
1122 OLD POLK CITY RD, LAKELAND, FL 33809-6622
(863) 858-2828
Taxonomy
Speciality
Code
Description
License number
State
1835G0303X
Geriatric Pharmacist
PU00102
FL
1835P2201X
Ambulatory Care Pharmacist
Primary
PS11329
FL
Other
Enumeration date
02/10/2017
Last updated
02/10/2017
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