Provider Demographics
NPI:1205146420
Name:PITTS, KENNETH RUSH (CPHT)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:RUSH
Last Name:PITTS
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 1:101 BARCLAY AVE
Mailing Address - Street 2:#5
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488-2860
Mailing Address - Country:US
Mailing Address - Phone:832-457-1261
Mailing Address - Fax:
Practice Address - Street 1:101 BARCLAY AVE
Practice Address - Street 2:#5
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-2860
Practice Address - Country:US
Practice Address - Phone:832-457-1261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX184434183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician