Provider Demographics
NPI:1124161690
Name:KENDRICK, DAVID SCOTT (RPH)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:SCOTT
Last Name:KENDRICK
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 1:704 WANDERING LN
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:WV
Mailing Address - Zip Code:25813-9488
Mailing Address - Country:US
Mailing Address - Phone:304-763-5236
Mailing Address - Fax:304-256-6258
Practice Address - Street 1:2157 RITTER DR
Practice Address - Street 2:
Practice Address - City:DANIELS
Practice Address - State:WV
Practice Address - Zip Code:25832-9371
Practice Address - Country:US
Practice Address - Phone:304-763-4326
Practice Address - Fax:304-763-4581
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0004945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist