Provider Demographics
NPI:1295337657
Name:KOKENGE, SHAWN ROBERT
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:ROBERT
Last Name:KOKENGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3254 KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-2157
Mailing Address - Country:US
Mailing Address - Phone:785-776-4100
Mailing Address - Fax:
Practice Address - Street 1:3254 KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-2157
Practice Address - Country:US
Practice Address - Phone:785-776-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-11676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist