Provider Demographics
NPI:1932103280
Name:PATTISON, KENT L (R PH)
Entity Type:Individual
Prefix:MR
First Name:KENT
Middle Name:L
Last Name:PATTISON
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 PADEN RD
Mailing Address - Street 2:
Mailing Address - City:NEW CONCORD
Mailing Address - State:OH
Mailing Address - Zip Code:43762-9792
Mailing Address - Country:US
Mailing Address - Phone:740-826-4379
Mailing Address - Fax:
Practice Address - Street 1:53 PADEN RD
Practice Address - Street 2:
Practice Address - City:NEW CONCORD
Practice Address - State:OH
Practice Address - Zip Code:43762-9792
Practice Address - Country:US
Practice Address - Phone:740-826-4379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:2005-06-21
Deactivation Code:
Reactivation Date:2005-10-14
Provider Licenses
StateLicense IDTaxonomies
OH03-3-08920183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist