Provider Demographics
NPI:1992075642
Name:SMITH, KENDRA LYNN (RPH)
Entity type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1788 OLD HUDSON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119-4307
Mailing Address - Country:US
Mailing Address - Phone:651-731-9633
Mailing Address - Fax:651-731-9678
Practice Address - Street 1:1788 OLD HUDSON RD
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55119-4307
Practice Address - Country:US
Practice Address - Phone:651-731-9633
Practice Address - Fax:651-731-9678
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117860183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist