Provider Demographics
NPI:1558052639
Name:HIBBITTS, KENNETH STEPHEN
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:STEPHEN
Last Name:HIBBITTS
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:PO BOX 6295
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29804-6295
Mailing Address - Country:US
Mailing Address - Phone:803-648-7800
Mailing Address - Fax:803-648-7277
Practice Address - Street 1:190 CREPE MYRTLE DR
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-7543
Practice Address - Country:US
Practice Address - Phone:803-648-7800
Practice Address - Fax:803-648-7277
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43309183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist