Healthcare Provider Details

I. General information

NPI: 1396897443
Provider Name (Legal Business Name): MARTIN JOHN KENDRA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 W MAIN ST
BIRDSBORO PA
19508-1900
US

IV. Provider business mailing address

8 HASTINGS LN
SPRING CITY PA
19475-8614
US

V. Phone/Fax

Practice location:
  • Phone: 610-582-4005
  • Fax: 610-404-4512
Mailing address:
  • Phone: 610-495-0055
  • Fax: 610-495-0177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP030102L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: