Provider Demographics
NPI:1386253805
Name:WHITE, KENDRA R (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:R
Last Name:WHITE
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:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:MO
Mailing Address - Zip Code:65712-0068
Mailing Address - Country:US
Mailing Address - Phone:417-466-2000
Mailing Address - Fax:417-466-2028
Practice Address - Street 1:606 E MOUNT VERNON BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:MO
Practice Address - Zip Code:65712-9100
Practice Address - Country:US
Practice Address - Phone:417-466-2000
Practice Address - Fax:417-466-2028
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018025559183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist