Healthcare Provider Details

I. General information

NPI: 1336141605
Provider Name (Legal Business Name): KENDRA JEANNE GRANDE R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 10/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17052 PALE ANEMONE ST
PARKER CO
80134
US

IV. Provider business mailing address

17052 PALE ANEMONE ST
PARKER CO
80134
US

V. Phone/Fax

Practice location:
  • Phone: 720-851-9590
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2749
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14801
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: