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General NPI Number Information
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NPI Number | 1821718859
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Entity Type | Individual
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Provider Name | KENAN LEROY DENTEN DOCTOR OF PHARMACY
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Gender | Male
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Dates
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Enumeration Date | 08/30/2022
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Last Update Date | 08/30/2022
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Provider Practice Location Address
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Address Line | 318 W MAIN ST
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City | BOISE CITY
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State | OK
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Zip | 73933-9607
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Country | US
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Telephone | 580-544-3441
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Fax | 405-767-0905
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Provider Business Mailing Address
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Address Line | PO BOX 97
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City | BOISE CITY
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State | OK
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Zip | 73933-0097
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Country | US
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Telephone | 580-544-3441
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Fax | 405-767-0905
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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 | 17563
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License Number State | OK
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