Provider Demographics
NPI:1912215468
Name:JENT, ELBERT OLIN JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:ELBERT
Middle Name:OLIN
Last Name:JENT
Suffix:JR
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 1:479 HUNTERS CROSSING WAY
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-8526
Mailing Address - Country:US
Mailing Address - Phone:270-783-0099
Mailing Address - Fax:
Practice Address - Street 1:502 E HAPPY VALLEY ST
Practice Address - Street 2:
Practice Address - City:CAVE CITY
Practice Address - State:KY
Practice Address - Zip Code:42127-8845
Practice Address - Country:US
Practice Address - Phone:270-773-2101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9334183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist