Provider Demographics
NPI:1376085886
Name:KENT, KIMILIA JENAE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KIMILIA
Middle Name:JENAE
Last Name:KENT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5257 NE MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-3282
Mailing Address - Country:US
Mailing Address - Phone:503-676-3710
Mailing Address - Fax:
Practice Address - Street 1:5257 NE MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-3282
Practice Address - Country:US
Practice Address - Phone:503-676-3710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-00157291835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist