MEDICARE: MR. MARK KENDRICK RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	21208	TX

General Provider Information

NPI Number	:	1306846316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK KENDRICK RPH

Provider Business Mailing Address
First Line	:	7605 CERVIN DR
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79121-1201
Country	:	US
Telephone Number	:	806-358-3851
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 WALLACE BLVD
Second Line	:	PHARMACY
City	:	AMARILLO
State	:	TX
Zip	:	79106-1799
Country	:	US
Telephone Number	:	806-212-5372
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	07/08/2007

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