Provider Demographics
NPI:1669711362
Name:HUBBARD, KEVIN DUANE (RPH)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:DUANE
Last Name:HUBBARD
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 1:11847 KINGSTON PIKE
Mailing Address - Street 2:
Mailing Address - City:FARRAGUT
Mailing Address - State:TN
Mailing Address - Zip Code:37934-3833
Mailing Address - Country:US
Mailing Address - Phone:865-777-2469
Mailing Address - Fax:865-777-2470
Practice Address - Street 1:11847 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:FARRAGUT
Practice Address - State:TN
Practice Address - Zip Code:37934-3833
Practice Address - Country:US
Practice Address - Phone:865-777-2469
Practice Address - Fax:865-777-2470
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist