Provider Demographics
NPI:1073854790
Name:KENT, MICHELLE LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:KENT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 ERICSSON DR STE 100
Mailing Address - Street 2:
Mailing Address - City:WARRENDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15086-6501
Mailing Address - Country:US
Mailing Address - Phone:724-742-2468
Mailing Address - Fax:
Practice Address - Street 1:3000 ERICSSON DR STE 100
Practice Address - Street 2:
Practice Address - City:WARRENDALE
Practice Address - State:PA
Practice Address - Zip Code:15086-6501
Practice Address - Country:US
Practice Address - Phone:724-742-2468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP446047183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist