Provider Demographics
NPI:1174595649
Name:REDLAND, KENT L (RPH)
Entity type:Individual
Prefix:MR
First Name:KENT
Middle Name:L
Last Name:REDLAND
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 1:2785 IVY LN NE
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-5305
Mailing Address - Country:US
Mailing Address - Phone:218-444-9889
Mailing Address - Fax:
Practice Address - Street 1:2785 IVY LN NE
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-5305
Practice Address - Country:US
Practice Address - Phone:218-444-9889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115338-3183500000X
ND3947183500000X
SDR4623183500000X
WI16182-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist