Healthcare Provider Details

I. General information

NPI: 1679986871
Provider Name (Legal Business Name): KENDRA WINFREY PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3531 AIRLINE BLVD
PORTSMOUTH VA
23701-2642
US

IV. Provider business mailing address

3531 AIRLINE BLVD
PORTSMOUTH VA
23701-2642
US

V. Phone/Fax

Practice location:
  • Phone: 757-488-2880
  • Fax:
Mailing address:
  • Phone: 757-488-2880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202211607
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: