Provider Demographics
NPI:1700819984
Name:KENTCO INC
Entity Type:Organization
Organization Name:KENTCO INC
Other - Org Name:KENT'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:K
Authorized Official - Last Name:CROOKSTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:435-257-0445
Mailing Address - Street 1:300 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TREMONTON
Mailing Address - State:UT
Mailing Address - Zip Code:84337-2319
Mailing Address - Country:US
Mailing Address - Phone:435-257-0445
Mailing Address - Fax:435-257-6293
Practice Address - Street 1:300 E MAIN ST
Practice Address - Street 2:
Practice Address - City:TREMONTON
Practice Address - State:UT
Practice Address - Zip Code:84337-2319
Practice Address - Country:US
Practice Address - Phone:435-257-0445
Practice Address - Fax:435-257-6293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13106489131835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========009Medicaid
UT4465010001Medicare NSC