Provider Demographics
NPI:1760599369
Name:TENER, GARY A (RPH)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:A
Last Name:TENER
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:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-0305
Mailing Address - Country:US
Mailing Address - Phone:606-789-5995
Mailing Address - Fax:606-788-9275
Practice Address - Street 1:209-B NORTH MAYO TRAIL
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-0305
Practice Address - Country:US
Practice Address - Phone:606-789-5995
Practice Address - Fax:606-788-9275
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011696183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY011696OtherKENTUCKY STATE LICENSE