Provider Demographics
NPI:1407164130
Name:LENZIE, KENT (RPH)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:
Last Name:LENZIE
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 1:7455 N 95TH AVE APT 1217
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-1359
Mailing Address - Country:US
Mailing Address - Phone:623-907-6161
Mailing Address - Fax:
Practice Address - Street 1:11425 W BUCKEYE RD
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-6810
Practice Address - Country:US
Practice Address - Phone:623-907-6161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSO14889183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist