Provider Demographics
NPI:1366720690
Name:KENTERA, MILO K
Entity type:Individual
Prefix:
First Name:MILO
Middle Name:K
Last Name:KENTERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 W SAN CARLOS ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-3444
Mailing Address - Country:US
Mailing Address - Phone:408-882-0988
Mailing Address - Fax:
Practice Address - Street 1:1300 W SAN CARLOS ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-3444
Practice Address - Country:US
Practice Address - Phone:408-882-0988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21658183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist