MEDICARE: MR. JOHN S GENTRY PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	012997	KY

General Provider Information

NPI Number	:	1306935416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN S GENTRY PHARM.D.

Provider Business Mailing Address
First Line	:	101 LEGION DR
Second Line	:
City	:	CENTRAL CITY
State	:	KY
Zip	:	42330-1496
Country	:	US
Telephone Number	:	270-754-4300
Fax Number	:	270-754-9881

Provider Business Practice Location Address
First Line	:	101 LEGION DR
Second Line	:
City	:	CENTRAL CITY
State	:	KY
Zip	:	42330-1496
Country	:	US
Telephone Number	:	270-754-4300
Fax Number	:	270-754-9881

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/08/2007

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Directions to “ MR. JOHN S GENTRY PHARM.D.” Practice Location

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