MEDICARE: MR. ELBERT OLIN JENT JR. RPH

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	9334	KY

General Provider Information

NPI Number	:	1912215468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ELBERT OLIN JENT JR. RPH

Provider Business Mailing Address
First Line	:	479 HUNTERS CROSSING WAY
Second Line	:
City	:	BOWLING GREEN
State	:	KY
Zip	:	42104-8526
Country	:	US
Telephone Number	:	270-783-0099
Fax Number	:

Provider Business Practice Location Address
First Line	:	502 E HAPPY VALLEY ST
Second Line	:
City	:	CAVE CITY
State	:	KY
Zip	:	42127-8845
Country	:	US
Telephone Number	:	270-773-2101
Fax Number	:

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

Provider Enumeration Date	:	09/17/2010
Last Update Date	:	09/17/2010

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