Healthcare Provider Details

I. General information

NPI: 1790795219
Provider Name (Legal Business Name): HKA CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 W DAGGETT ST
PECOS TX
79772-6902
US

IV. Provider business mailing address

925 W DAGGETT ST
PECOS TX
79772-6902
US

V. Phone/Fax

Practice location:
  • Phone: 432-447-2266
  • Fax: 432-447-3909
Mailing address:
  • Phone: 432-447-2266
  • Fax: 432-447-3909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24494
License Number StateTX

VIII. Authorized Official

Name: MR. LEO HUNG
Title or Position: PHARMACIST
Credential:
Phone: 432-447-2266