Provider Demographics
NPI:1083849079
Name:MUNGER, KENT D (RPH)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:D
Last Name:MUNGER
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 1:401 INGALLS AVE SW
Mailing Address - Street 2:
Mailing Address - City:DE SMET
Mailing Address - State:SD
Mailing Address - Zip Code:57231-2234
Mailing Address - Country:US
Mailing Address - Phone:605-203-1194
Mailing Address - Fax:
Practice Address - Street 1:401 INGALLS AVE SW
Practice Address - Street 2:
Practice Address - City:DE SMET
Practice Address - State:SD
Practice Address - Zip Code:57231-2234
Practice Address - Country:US
Practice Address - Phone:605-203-1194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4583183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist