Provider Demographics
NPI:1871682104
Name:KENT PHARMACY INC
Entity Type:Organization
Organization Name:KENT PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHARMACIST IN CHARGE
Authorized Official - Prefix:MS
Authorized Official - First Name:FEMA
Authorized Official - Middle Name:MANLANGIT
Authorized Official - Last Name:ARCILLA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:213-413-7744
Mailing Address - Street 1:707 N ALVARADO ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-4005
Mailing Address - Country:US
Mailing Address - Phone:213-413-7744
Mailing Address - Fax:
Practice Address - Street 1:707 N ALVARADO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-4005
Practice Address - Country:US
Practice Address - Phone:213-413-7744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY450043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA450040Medicaid