Provider Demographics
NPI:1336293208
Name:ROBINSON, KEN N (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEN
Middle Name:N
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 N FOWLER ST
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-2347
Mailing Address - Country:US
Mailing Address - Phone:505-392-6516
Mailing Address - Fax:505-392-8236
Practice Address - Street 1:2420 N FOWLER ST
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-2347
Practice Address - Country:US
Practice Address - Phone:505-392-6516
Practice Address - Fax:505-392-8236
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3922183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM3207215OtherNCPDP PHARMACY ID
NM58230Medicaid
NM0444350001Medicare NSC