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General NPI Number Information
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NPI Number | 1679917850
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Entity Type | Individual
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Provider Name | KENDRA MANIGAULT PHARMD
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Gender | Female
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Dates
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Enumeration Date | 04/18/2013
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Last Update Date | 04/18/2013
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Provider Practice Location Address
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Address Line | 3001 MERCER UNIVERSITY DR
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City | ATLANTA
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State | GA
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Zip | 30341-4115
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Country | US
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Telephone | 843-312-9190
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 984
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City | MONCKS CORNER
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State | SC
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Zip | 29461-0984
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Country | US
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Telephone | 843-312-9190
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | RPH025494
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License Number State | GA
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