Individual
KENNETH FANNING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
555 CHARLIE SMITH SR HWY, SAINT MARYS, GA 31558-3030
(904) 616-9096
Mailing address
1536 N MARKET ST, JACKSONVILLE, FL 32206-4540
(904) 616-9096
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PHWH005053
GA
Other
Enumeration date
06/24/2021
Last updated
07/27/2021
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