Provider Demographics
NPI:1992792626
Name:KENDALL, KYLE DEAN (RPH)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:DEAN
Last Name:KENDALL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 W 5TH
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:TX
Mailing Address - Zip Code:79782
Mailing Address - Country:US
Mailing Address - Phone:432-756-2797
Mailing Address - Fax:432-756-2008
Practice Address - Street 1:201 N ST PETER ST
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:TX
Practice Address - Zip Code:79782
Practice Address - Country:US
Practice Address - Phone:432-756-3731
Practice Address - Fax:432-756-2008
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18835183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist