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General NPI Number Information
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NPI Number | 1932504008
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Entity Type | Individual
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Provider Name | KENDALL JEANNE BRENTON PHARMD
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Gender | Female
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Dates
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Enumeration Date | 10/30/2014
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Last Update Date | 09/11/2015
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Provider Practice Location Address
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Address Line | 400 BRIDGE ST
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City | CLARKSTON
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State | WA
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Zip | 99403-1931
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Country | US
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Telephone | 208-871-0041
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Fax |
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Provider Business Mailing Address
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Address Line | 305 SUSAN DR
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City | MOSCOW
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State | ID
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Zip | 83843-9482
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Country | US
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Telephone | 208-871-0041
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH60556897
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | P7357
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License Number State | ID
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