MEDICARE: DR. RALPH WOODROW KENDALL JR. PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	PS21168	FL

General Provider Information

NPI Number	:	1427215664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RALPH WOODROW KENDALL JR. PHARMD

Provider Business Mailing Address
First Line	:	1615 WATERMARK CIR NE
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33702-7068
Country	:	US
Telephone Number	:	813-769-1897
Fax Number	:

Provider Business Practice Location Address
First Line	:	5109 W LEMON ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-1102
Country	:	US
Telephone Number	:	813-769-1897
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	05/16/2008

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