Healthcare Provider Details

I. General information

NPI: 1508922162
Provider Name (Legal Business Name): RODNEY KENT HAHN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 MAIN ST
STOCKTON KS
67669-1930
US

IV. Provider business mailing address

402 MAIN ST
STOCKTON KS
67669-1930
US

V. Phone/Fax

Practice location:
  • Phone: 785-425-7172
  • Fax: 785-425-6611
Mailing address:
  • Phone: 785-425-7172
  • Fax: 785-425-6611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11355
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: