Provider Demographics
NPI:1376826941
Name:JENT, KAREN THERESA
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:THERESA
Last Name:JENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-2640
Mailing Address - Country:US
Mailing Address - Phone:502-361-2349
Mailing Address - Fax:502-367-0273
Practice Address - Street 1:5201 S 3RD ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-2640
Practice Address - Country:US
Practice Address - Phone:502-361-2349
Practice Address - Fax:502-367-0273
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist