Provider Demographics
NPI:1154919009
Name:DAVIS, KENT EARLE (RPH)
Entity type:Individual
Prefix:
First Name:KENT
Middle Name:EARLE
Last Name:DAVIS
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 1:41 HEATHERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BEDMINSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07921-2053
Mailing Address - Country:US
Mailing Address - Phone:267-337-2232
Mailing Address - Fax:908-326-3518
Practice Address - Street 1:41 HEATHERWOOD LN
Practice Address - Street 2:
Practice Address - City:BEDMINSTER
Practice Address - State:NJ
Practice Address - Zip Code:07921-2053
Practice Address - Country:US
Practice Address - Phone:267-337-2232
Practice Address - Fax:908-326-3518
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS22807183500000X
PARP034650L183500000X
NJ28RI03786400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist