Provider Demographics
NPI:1114520830
Name:LUMBATIS, KENT GREGORY
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:GREGORY
Last Name:LUMBATIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 W HUNTER ST
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-1014
Mailing Address - Country:US
Mailing Address - Phone:740-385-8581
Mailing Address - Fax:
Practice Address - Street 1:1390 W HUNTER ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-1014
Practice Address - Country:US
Practice Address - Phone:740-385-8581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03217780183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist