Provider Demographics
NPI:1619046539
Name:TENREIRO, KIM ANTHONY (RPH)
Entity Type:Individual
Prefix:MR
First Name:KIM
Middle Name:ANTHONY
Last Name:TENREIRO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4069 WHITETAIL DR
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-9368
Mailing Address - Country:US
Mailing Address - Phone:585-396-9970
Mailing Address - Fax:585-396-7264
Practice Address - Street 1:66 WEST AVE
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1521
Practice Address - Country:US
Practice Address - Phone:585-396-9970
Practice Address - Fax:585-396-7264
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY034297-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY034297-1OtherN.Y. PHARMACIST LICENSE