Provider Demographics
NPI:1912550898
Name:HERTEL, WILLIAM KENT
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:KENT
Last Name:HERTEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N DENTON TAP RD
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-2162
Mailing Address - Country:US
Mailing Address - Phone:469-322-6815
Mailing Address - Fax:469-322-6816
Practice Address - Street 1:700 N DENTON TAP RD
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-2162
Practice Address - Country:US
Practice Address - Phone:469-322-6815
Practice Address - Fax:469-322-6816
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32243183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist