Healthcare Provider Details

I. General information

NPI: 1548570419
Provider Name (Legal Business Name): KENDRA OLIVIA DEAL CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2010
Last Update Date: 10/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14405 RIO BONITO RD APT 483
HOUSTON TX
77083-1542
US

IV. Provider business mailing address

14405 RIO BONITO RD APT 483
HOUSTON TX
77083-1542
US

V. Phone/Fax

Practice location:
  • Phone: 832-349-0567
  • Fax:
Mailing address:
  • Phone: 832-349-0567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number184694
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: