Provider Demographics
NPI:1629670724
Name:SEEVER, KENNETH (RPH)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:SEEVER
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:PO BOX 921
Mailing Address - Street 2:
Mailing Address - City:CUSHING
Mailing Address - State:OK
Mailing Address - Zip Code:74023-0921
Mailing Address - Country:US
Mailing Address - Phone:918-225-4622
Mailing Address - Fax:
Practice Address - Street 1:3100 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:OK
Practice Address - Zip Code:74023-3072
Practice Address - Country:US
Practice Address - Phone:918-225-6320
Practice Address - Fax:918-306-0282
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8623183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist