Provider Demographics
NPI:1336428028
Name:HATCH, KENNETH (RPH)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:HATCH
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 1:6116 NE MLK JR BLVD
Mailing Address - Street 2:PHARMACY DEPT
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-3159
Mailing Address - Country:US
Mailing Address - Phone:503-282-0689
Mailing Address - Fax:
Practice Address - Street 1:6116 NE MLK JR BLVD
Practice Address - Street 2:PHARMACY DEPT
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-3159
Practice Address - Country:US
Practice Address - Phone:503-282-0689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0006729183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist