Provider Demographics
NPI:1689805772
Name:HUBBARD, KENNETH A SR (RPH)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:A
Last Name:HUBBARD
Suffix:SR
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 1:24 W BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-2051
Mailing Address - Country:US
Mailing Address - Phone:315-343-5722
Mailing Address - Fax:315-343-0085
Practice Address - Street 1:3318 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:NY
Practice Address - Zip Code:13114
Practice Address - Country:US
Practice Address - Phone:315-963-0601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033349183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist