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General NPI Number Information
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NPI Number | 1366654675
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Entity Type | Organization
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Legal Business Name | KENS RX DISCOUNT PHARMACY
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 08/03/2015
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Provider Practice Location Address
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Address Line | 802 W GORE BLVD
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City | LAWTON
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State | OK
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Zip | 73501-3719
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Country | US
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Telephone | 580-353-4113
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Fax | 580-357-3862
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Provider Business Mailing Address
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Address Line | 802 W GORE BLVD
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City | LAWTON
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State | OK
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Zip | 73501-3719
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Country | US
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Telephone | 580-353-4113
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Fax | 580-357-3862
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Authorized Official
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Title or Position | PARTNER
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Name | MR. KENNETH ROYCE HAWKINS
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Credential | DPH
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Telephone | 580-353-4113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 3-5058
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 3-5058
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License Number State | OK
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