Provider Demographics
NPI:1851674543
Name:KINDSETH, ELKANAH ISRAEL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ELKANAH
Middle Name:ISRAEL
Last Name:KINDSETH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-1311
Mailing Address - Country:US
Mailing Address - Phone:309-830-6687
Mailing Address - Fax:417-532-9743
Practice Address - Street 1:1114 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-1311
Practice Address - Country:US
Practice Address - Phone:309-830-6687
Practice Address - Fax:417-532-9743
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011023692183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist