Provider Demographics
NPI:1215234711
Name:GIRTEN, VANCE D
Entity type:Individual
Prefix:
First Name:VANCE
Middle Name:D
Last Name:GIRTEN
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 1:1156 CARTER RD
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-2644
Mailing Address - Country:US
Mailing Address - Phone:270-683-7010
Mailing Address - Fax:270-683-7342
Practice Address - Street 1:1156 CARTER RD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-2644
Practice Address - Country:US
Practice Address - Phone:270-683-7010
Practice Address - Fax:270-683-7342
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014922183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist