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General NPI Number Information
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NPI Number | 1902999345
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Entity Type | Organization
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Legal Business Name | KEN'S HEALTHMART LLC
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Dates
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Enumeration Date | 09/30/2006
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Last Update Date | 01/13/2016
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Provider Practice Location Address
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Address Line | 200 S HIGHLAND AVE
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City | CUSHING
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State | OK
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Zip | 74023-4117
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Country | US
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Telephone | 918-225-5200
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Fax | 918-225-0828
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Provider Business Mailing Address
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Address Line | 200 S HIGHLAND AVE
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City | CUSHING
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State | OK
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Zip | 74023-4117
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Country | US
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Telephone | 918-225-5200
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Fax | 918-225-0828
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Authorized Official
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Title or Position | OWNER
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Name | KEN HIBBARD
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Credential | RPH
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Telephone | 918-225-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 8-2834
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License Number State | OK
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