MEDICARE: KENDRA L DAVIS CPHT, RPHT

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	183700000X	Pharmacy Technician	42683	FL

General Provider Information

NPI Number	:	1548838949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA L DAVIS CPHT, RPHT

Provider Business Mailing Address
First Line	:	13990 BARTRAM PARK BLVD UNIT 701
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-5549
Country	:	US
Telephone Number	:	786-910-8938
Fax Number	:	904-296-5871

Provider Business Practice Location Address
First Line	:	4203 BELFORT RD STE 215
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-1416
Country	:	US
Telephone Number	:	904-296-5870
Fax Number	:	904-296-5871

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

Provider Enumeration Date	:	06/14/2021
Last Update Date	:	06/14/2021

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