Provider Demographics
NPI:1316274210
Name:HATLEY, KENNETH ROBERTS (RPH)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:ROBERTS
Last Name:HATLEY
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 1:1542 N CEDAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-5206
Mailing Address - Country:US
Mailing Address - Phone:972-780-8277
Mailing Address - Fax:972-780-8277
Practice Address - Street 1:7586 MOUNTAIN CREEK PKWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75249-1356
Practice Address - Country:US
Practice Address - Phone:972-572-2423
Practice Address - Fax:972-572-2428
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29055183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist