Provider Demographics
NPI:1366814055
Name:FAUSKA, KENDY ROSE (RPH)
Entity type:Individual
Prefix:MRS
First Name:KENDY
Middle Name:ROSE
Last Name:FAUSKA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:KENDY
Other - Middle Name:ROSE
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:4813 SAWYERS DR
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-2950
Mailing Address - Country:US
Mailing Address - Phone:515-229-9563
Mailing Address - Fax:
Practice Address - Street 1:4813 SAWYERS DR
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-2950
Practice Address - Country:US
Practice Address - Phone:515-229-9563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18681183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist