Provider Demographics
NPI:1174818546
Name:PAINTER, KENT TITUS (RPH)
Entity Type:Individual
Prefix:MR
First Name:KENT
Middle Name:TITUS
Last Name:PAINTER
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 1:1395D WESTERN BLVD
Mailing Address - Street 2:T-1226
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6663
Mailing Address - Country:US
Mailing Address - Phone:910-937-6639
Mailing Address - Fax:910-937-6639
Practice Address - Street 1:1395D WESTERN BLVD
Practice Address - Street 2:T-1226
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6663
Practice Address - Country:US
Practice Address - Phone:910-937-6639
Practice Address - Fax:910-937-6639
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9938183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist