Basic Information
| Provider Information | |||||||||
| NPI: | 1366170573 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KENDREX | ||||||||
| FirstName: | HAILEY | ||||||||
| MiddleName: | |||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1633 ROCKWATER BLVD APT 108 | ||||||||
| Address2: | |||||||||
| City: | NORTH LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721144259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702778492 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8801 HIGHWAY 107 | ||||||||
| Address2: | |||||||||
| City: | SHERWOOD | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721202929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5018333116 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2022 | ||||||||
| LastUpdateDate: | 08/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PD15902 | AR | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.