Healthcare Provider Details

I. General information

NPI: 1184730418
Provider Name (Legal Business Name): KEN HEWITT RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 MORGANS RD
ANIAK AK
99557
US

IV. Provider business mailing address

PO BOX 2
ANIAK AK
99557-0002
US

V. Phone/Fax

Practice location:
  • Phone: 907-675-4556
  • Fax: 907-675-4693
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1369
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: