Provider Demographics
NPI:1386944353
Name:KANTOR, MARK ANDREW (RPH)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANDREW
Last Name:KANTOR
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 1:1328 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7561
Mailing Address - Country:US
Mailing Address - Phone:541-608-3686
Mailing Address - Fax:541-608-3689
Practice Address - Street 1:1701 NE 7TH ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1319
Practice Address - Country:US
Practice Address - Phone:541-471-4106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9512183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist