Provider Demographics
NPI:1427729615
Name:KENDALL, MICAH COLE
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:COLE
Last Name:KENDALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 3RD ST
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:MO
Mailing Address - Zip Code:64776-2934
Mailing Address - Country:US
Mailing Address - Phone:417-646-2301
Mailing Address - Fax:417-646-2456
Practice Address - Street 1:112 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:KS
Practice Address - Zip Code:67054-1724
Practice Address - Country:US
Practice Address - Phone:620-723-3112
Practice Address - Fax:620-723-3421
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021027219183500000X
KS1-103795183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist