Healthcare Provider Details

I. General information

NPI: 1114098605
Provider Name (Legal Business Name): JEFF KENDRICK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 NW 11TH ST
HERMISTON OR
97838-6601
US

IV. Provider business mailing address

610 NW 11TH ST
HERMISTON OR
97838-6601
US

V. Phone/Fax

Practice location:
  • Phone: 541-667-3647
  • Fax: 541-667-3454
Mailing address:
  • Phone: 541-667-3647
  • Fax: 541-667-3454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0008248
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: