Provider Demographics
NPI:1578203238
Name:HAMBY, KENNETH LANE (CPHT)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:LANE
Last Name:HAMBY
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 JOINER HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:ROCKWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37854-4914
Mailing Address - Country:US
Mailing Address - Phone:256-366-9083
Mailing Address - Fax:
Practice Address - Street 1:82 ELMORE RD
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-6071
Practice Address - Country:US
Practice Address - Phone:931-456-5023
Practice Address - Fax:931-456-1106
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN70992183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician