Provider Demographics
NPI:1841250164
Name:LANCASTER, KEN (PD)
Entity type:Individual
Prefix:
First Name:KEN
Middle Name:
Last Name:LANCASTER
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5152 HIGHWAY 51 S
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-8360
Mailing Address - Country:US
Mailing Address - Phone:870-245-6558
Mailing Address - Fax:870-246-6990
Practice Address - Street 1:5152 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-8360
Practice Address - Country:US
Practice Address - Phone:870-245-6558
Practice Address - Fax:870-246-6990
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR06624183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist