Provider Demographics
NPI:1124616453
Name:COLSON, KENDRA JEAN (PHARMD)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:JEAN
Last Name:COLSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5817 PATTON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-2428
Mailing Address - Country:US
Mailing Address - Phone:361-806-9100
Mailing Address - Fax:361-806-9449
Practice Address - Street 1:5817 PATTON ST STE 100
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-2428
Practice Address - Country:US
Practice Address - Phone:361-806-9100
Practice Address - Fax:361-806-9449
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-03
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56840183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist