Healthcare Provider Details

I. General information

NPI: 1023190410
Provider Name (Legal Business Name): KENDA KAY JEFFERSON RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 HARDEE AVE SW ATTN: PHARMACY SERVICE
FT. MCPHERSON GA
30330-1062
US

IV. Provider business mailing address

7265 MADISON CIR
UNION CITY GA
30291-5161
US

V. Phone/Fax

Practice location:
  • Phone: 404-464-0296
  • Fax: 404-464-0303
Mailing address:
  • Phone: 770-964-9379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-2-19467
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: