Organization
KEN'S HEALTHMART LLC
Active
Other names
KENS HEALTHMART PHARMACY LLC
Organization subpart
No
Provider details
NPI number
Authorized official
KEN HIBBARD RPH (OWNER)
(918) 225-5200
Entity
Organization
Contact information
Practice address
200 S HIGHLAND AVE, CUSHING, OK 74023-4117
(918) 225-5200
(918) 225-0828
Mailing address
200 S HIGHLAND AVE, CUSHING, OK 74023-4117
(918) 225-5200
(918) 225-0828
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
8-2834
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100235560A
—
OK
01
—
2073600
PK
—
Enumeration date
09/30/2006
Last updated
01/13/2016
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