MEDICARE: KENNETH KENT PHARMD

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	228559	AK

General Provider Information

NPI Number	:	1316753247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH KENT PHARMD

Provider Business Mailing Address
First Line	:	PO BOX 240009
Second Line	:
City	:	DOUGLAS
State	:	AK
Zip	:	99824-0009
Country	:	US
Telephone Number	:	913-608-1284
Fax Number	:

Provider Business Practice Location Address
First Line	:	8181 GLACIER HWY
Second Line	:
City	:	JUNEAU
State	:	AK
Zip	:	99801-6920
Country	:	US
Telephone Number	:	907-789-6533
Fax Number	:

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

Provider Enumeration Date	:	12/05/2024
Last Update Date	:	12/05/2024

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Directions to “ KENNETH KENT PHARMD” Practice Location

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