Individual
KACI BOULWARE KENON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
3851 CHAPEL HILL ROAD, DOUGLASVILLE, GA 30135
(678) 715-2578
Mailing address
1124 WILLOW CREST WAY, AUSTELL, GA 30168
(305) 528-0270
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH020323
GA
Other
Enumeration date
09/13/2011
Last updated
09/13/2011
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