Provider Demographics
NPI:1679560072
Name:ZELLNER, KENT ALLEN (RPH)
Entity type:Individual
Prefix:MR
First Name:KENT
Middle Name:ALLEN
Last Name:ZELLNER
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 1:1512 S COUNTY ROAD 15
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-8404
Mailing Address - Country:US
Mailing Address - Phone:419-447-8894
Mailing Address - Fax:419-447-0177
Practice Address - Street 1:240 W MARKET ST
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-2701
Practice Address - Country:US
Practice Address - Phone:419-447-0077
Practice Address - Fax:419-447-0177
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-15305183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist