Provider Demographics
NPI:1003206442
Name:WALDRON, KENT (RPH)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:
Last Name:WALDRON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 579
Mailing Address - Street 2:305 N PARK
Mailing Address - City:JOHNSON
Mailing Address - State:KS
Mailing Address - Zip Code:67855-0579
Mailing Address - Country:US
Mailing Address - Phone:620-492-3263
Mailing Address - Fax:620-492-3318
Practice Address - Street 1:111 S. MAIN
Practice Address - Street 2:
Practice Address - City:JOHNSON
Practice Address - State:KS
Practice Address - Zip Code:67855-0579
Practice Address - Country:US
Practice Address - Phone:620-492-3263
Practice Address - Fax:620-492-3318
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-12675183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist