Provider Demographics
NPI:1013249572
Name:HOLDER, KENNETH MITCHELL (RPH)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:MITCHELL
Last Name:HOLDER
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 1:1320 E 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-4233
Mailing Address - Country:US
Mailing Address - Phone:620-669-8559
Mailing Address - Fax:620-663-4156
Practice Address - Street 1:1320 E 30TH AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-4233
Practice Address - Country:US
Practice Address - Phone:620-669-8559
Practice Address - Fax:620-663-4156
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9816183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist