Organization
KENS RX DISCOUNT PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH ROYCE HAWKINS DPH (PARTNER)
(580) 353-4113
Entity
Organization
Contact information
Practice address
802 W GORE BLVD, LAWTON, OK 73501-3719
(580) 353-4113
(580) 357-3862
Mailing address
802 W GORE BLVD, LAWTON, OK 73501-3719
(580) 353-4113
(580) 357-3862
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
3-5058
OK
333600000X
Pharmacy
Primary
3-5058
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100239000B
—
OK
01
—
423407
MEDICARE ID-TYPE UNSPECIFIED
OK
Enumeration date
05/07/2007
Last updated
08/03/2015
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