Healthcare Provider Details

I. General information

NPI: 1730230665
Provider Name (Legal Business Name): KENS RX DISCOUNT PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 W GORE BLVD
LAWTON OK
73501-3719
US

IV. Provider business mailing address

802 W GORE BLVD
LAWTON OK
73501-3719
US

V. Phone/Fax

Practice location:
  • Phone: 580-353-4113
  • Fax: 580-357-3862
Mailing address:
  • Phone: 580-353-4113
  • Fax: 580-357-3862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number3-5058
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ALECE NEWELL
Title or Position: PHARMACY PARTNER
Credential: DPH
Phone: 580-353-4113