Provider Demographics
NPI:1043352271
Name:GASKINS, KENNETH DAVID
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:DAVID
Last Name:GASKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 PEACHBELT RD
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-5472
Mailing Address - Country:US
Mailing Address - Phone:706-647-8253
Mailing Address - Fax:770-567-5222
Practice Address - Street 1:119 CONCORD STREET
Practice Address - Street 2:
Practice Address - City:ZEBULON
Practice Address - State:GA
Practice Address - Zip Code:30295
Practice Address - Country:US
Practice Address - Phone:770-567-8844
Practice Address - Fax:770-567-5222
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA14242183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist