Provider Demographics
NPI:1851607485
Name:KITCHENS, PAUL (RPH)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:KITCHENS
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 1:3630 INTERSTATE 35 S
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76706-3755
Mailing Address - Country:US
Mailing Address - Phone:254-662-7510
Mailing Address - Fax:
Practice Address - Street 1:3630 INTERSTATE 35 S
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76706-3755
Practice Address - Country:US
Practice Address - Phone:254-662-7510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist