Provider Demographics
NPI:1053491191
Name:KENTROY
Entity Type:Organization
Organization Name:KENTROY
Other - Org Name:KENTS MARKET PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:BEKSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-985-3940
Mailing Address - Street 1:3535 W 5600 S
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-9111
Mailing Address - Country:US
Mailing Address - Phone:801-985-3942
Mailing Address - Fax:801-985-3944
Practice Address - Street 1:3535 W 5600 S
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-9111
Practice Address - Country:US
Practice Address - Phone:801-985-3942
Practice Address - Fax:801-985-3944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5073927-17033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT4696855OtherNCPDP
UTBK7770476OtherDEA NUMBER
UT4696855OtherNCPDP
UT4496240001Medicare ID - Type Unspecified