Basic Information
| Provider Information | |||||||||
| NPI: | 1952608887 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PACE | ||||||||
| FirstName: | KENESHA | ||||||||
| MiddleName: | DEON | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 126 MISSOURI AVE # 1240 | ||||||||
| Address2: | |||||||||
| City: | FORT LEONARD WOOD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 654738952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5735960515 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 126 MISSOURI AVE | ||||||||
| Address2: | #1240 | ||||||||
| City: | FORT LEONARDWOOD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 654738952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5735960515 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2011 | ||||||||
| LastUpdateDate: | 02/11/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P0018X | 018894 | LA | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.