Healthcare Provider Details

I. General information

NPI: 1275724379
Provider Name (Legal Business Name): WILLIAM B GENTLEMAN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 08/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ZORN AVE
LOUISVILLE KY
40206-1433
US

IV. Provider business mailing address

800 ZORN AVE
LOUISVILLE KY
40206-1433
US

V. Phone/Fax

Practice location:
  • Phone: 502-287-6179
  • Fax: 502-287-6967
Mailing address:
  • Phone: 502-287-6179
  • Fax: 502-287-6967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number009458
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: