Provider Demographics
NPI:1932729928
Name:KENTNER, ROGER ERVEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:ERVEN
Last Name:KENTNER
Suffix:
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 1:510 W MCLANE ST
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50213-1556
Mailing Address - Country:US
Mailing Address - Phone:641-342-1568
Mailing Address - Fax:641-342-1606
Practice Address - Street 1:510 W MCLANE ST
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:IA
Practice Address - Zip Code:50213-1556
Practice Address - Country:US
Practice Address - Phone:641-342-1568
Practice Address - Fax:641-342-1606
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAK-15042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist