Provider Demographics
NPI:1740735349
Name:CANTRELL, KEVIN RONDALL (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:RONDALL
Last Name:CANTRELL
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1923
Mailing Address - Country:US
Mailing Address - Phone:304-697-2151
Mailing Address - Fax:304-781-2694
Practice Address - Street 1:125 7TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-1923
Practice Address - Country:US
Practice Address - Phone:304-697-2151
Practice Address - Fax:304-781-2694
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0008218183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist