Provider Demographics
NPI:1487939443
Name:BOOKMAN, KENDRA BOLDS
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:BOLDS
Last Name:BOOKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 S ROBB ST
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:TX
Mailing Address - Zip Code:75862-7618
Mailing Address - Country:US
Mailing Address - Phone:936-594-2540
Mailing Address - Fax:
Practice Address - Street 1:515 S ROBB ST
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:TX
Practice Address - Zip Code:75862-7618
Practice Address - Country:US
Practice Address - Phone:936-594-2540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2025-09-08
Deactivation Date:2012-09-04
Deactivation Code:
Reactivation Date:2025-08-25
Provider Licenses
StateLicense IDTaxonomies
TX40214183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist