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General NPI Number Information
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NPI Number | 1689284630
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Entity Type | Individual
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Provider Name | KENT REGER NIEDENS PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 08/05/2020
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Last Update Date | 08/05/2020
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Provider Practice Location Address
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Address Line | 3025 LANCASTER DR NE
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City | SALEM
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State | OR
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Zip | 97305-1391
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Country | US
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Telephone | 503-378-7720
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Fax |
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Provider Business Mailing Address
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Address Line | 1194 SHIPPING ST NE
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City | SALEM
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State | OR
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Zip | 97301-7817
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Country | US
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Telephone | 406-579-2065
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PHA-PHA-LIC-71032
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH-0017981
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License Number State | OR
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