Provider Demographics
NPI:1750718268
Name:SANT, KEVIN G (PHARMACIST)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:G
Last Name:SANT
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21417 BUCKEYE LAKE LN
Mailing Address - Street 2:
Mailing Address - City:COLBERT
Mailing Address - State:WA
Mailing Address - Zip Code:99005-9191
Mailing Address - Country:US
Mailing Address - Phone:509-468-2584
Mailing Address - Fax:
Practice Address - Street 1:21417 BUCKEYE LAKE LN
Practice Address - Street 2:
Practice Address - City:COLBERT
Practice Address - State:WA
Practice Address - Zip Code:99005-9191
Practice Address - Country:US
Practice Address - Phone:509-468-2584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-28
Last Update Date:2013-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00047565183500000X
IDP5893183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist