Provider Demographics
NPI:1336359066
Name:HART, KENNETH SAMUEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:SAMUEL
Last Name:HART
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PMB 451, P.O. BOX 1003
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950
Mailing Address - Country:US
Mailing Address - Phone:670-234-6584
Mailing Address - Fax:670-234-3742
Practice Address - Street 1:OLEAI BUSINESS CENTER
Practice Address - Street 2:1ST FLOOR, BEACH ROAD
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:US
Practice Address - Phone:670-234-6584
Practice Address - Fax:670-234-3742
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MP0059183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist