Basic Information
| Provider Information | |||||||||
| NPI: | 1538785191 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KENDALL | ||||||||
| FirstName: | KAILEY | ||||||||
| MiddleName: | JO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5591 W MARVIN LN APT 213 | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837056232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087054339 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4840 N CLOVERDALE RD | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837132423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087068000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2020 | ||||||||
| LastUpdateDate: | 08/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | P8839 | ID | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.