Provider Demographics
NPI:1316753247
Name:KENT, KENNETH (PHARMD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:KENT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:KENNY
Other - Middle Name:
Other - Last Name:KENT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 240009
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AK
Mailing Address - Zip Code:99824-0009
Mailing Address - Country:US
Mailing Address - Phone:913-608-1284
Mailing Address - Fax:
Practice Address - Street 1:8181 GLACIER HWY
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-6920
Practice Address - Country:US
Practice Address - Phone:907-789-6533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2285591835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist