Provider Demographics
NPI:1932077161
Name:KENWORTHY, BRET ALLPHIN
Entity type:Individual
Prefix:
First Name:BRET
Middle Name:ALLPHIN
Last Name:KENWORTHY
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 1:495 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:LA VERKIN
Mailing Address - State:UT
Mailing Address - Zip Code:84745-5124
Mailing Address - Country:US
Mailing Address - Phone:435-635-6944
Mailing Address - Fax:435-635-1547
Practice Address - Street 1:495 N STATE ST
Practice Address - Street 2:
Practice Address - City:LA VERKIN
Practice Address - State:UT
Practice Address - Zip Code:84745-5124
Practice Address - Country:US
Practice Address - Phone:435-635-6944
Practice Address - Fax:435-635-1547
Is Sole Proprietor?:No
Enumeration Date:2025-10-28
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6517008-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist