Provider Demographics
NPI:1326386111
Name:MAURICE, KENT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:
Last Name:MAURICE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 ARIA WAY
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-9665
Mailing Address - Country:US
Mailing Address - Phone:209-380-2781
Mailing Address - Fax:209-845-9374
Practice Address - Street 1:3305 ARIA WAY
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-9665
Practice Address - Country:US
Practice Address - Phone:209-380-2781
Practice Address - Fax:209-845-9374
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47196183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist