MEDICARE: KENDRA OLIVIA DEAL CPHT

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	183700000X	Pharmacy Technician	184694	TX

General Provider Information

NPI Number	:	1548570419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA OLIVIA DEAL CPHT

Provider Business Mailing Address
First Line	:	14405 RIO BONITO RD
Second Line	:	APT 483
City	:	HOUSTON
State	:	TX
Zip	:	77083-1542
Country	:	US
Telephone Number	:	832-349-0567
Fax Number	:

Provider Business Practice Location Address
First Line	:	14405 RIO BONITO RD
Second Line	:	APT 483
City	:	HOUSTON
State	:	TX
Zip	:	77083-1542
Country	:	US
Telephone Number	:	832-349-0567
Fax Number	:

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

Provider Enumeration Date	:	10/13/2010
Last Update Date	:	10/13/2010

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