Provider Demographics
NPI:1477956506
Name:KON, DENNIS EUGENE (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:EUGENE
Last Name:KON
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:MR
Other - First Name:DENNIS
Other - Middle Name:EUGENE
Other - Last Name:KON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:1520 W MILLEN DR
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88242
Mailing Address - Country:US
Mailing Address - Phone:575-392-1116
Mailing Address - Fax:575-492-0315
Practice Address - Street 1:1520 W MILLEN DR
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88242
Practice Address - Country:US
Practice Address - Phone:575-392-1116
Practice Address - Fax:575-492-0315
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4350183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist