MEDICARE: DIANA MARIE KENDALL RPH

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	183500000X	Pharmacist	28RI01932700	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487961033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA MARIE KENDALL RPH

Provider Business Mailing Address
First Line	:	25 W MAIN ST
Second Line	:
City	:	MAPLE SHADE
State	:	NJ
Zip	:	08052-2411
Country	:	US
Telephone Number	:	856-779-7304
Fax Number	:	856-779-9022

Provider Business Practice Location Address
First Line	:	25 W MAIN ST
Second Line	:
City	:	MAPLE SHADE
State	:	NJ
Zip	:	08052-2411
Country	:	US
Telephone Number	:	856-779-7304
Fax Number	:	856-779-9022

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

Provider Enumeration Date	:	09/02/2010
Last Update Date	:	09/02/2010

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