Provider Demographics
NPI:1134400146
Name:LIPSCOMB, KENDRA JUANA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:JUANA
Last Name:LIPSCOMB
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1457 DONEGAL DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6056
Mailing Address - Country:US
Mailing Address - Phone:321-537-2611
Mailing Address - Fax:
Practice Address - Street 1:1457 DONEGAL DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-6056
Practice Address - Country:US
Practice Address - Phone:321-537-2611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL44513183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist