Provider Demographics
NPI:1801915855
Name:KENDALL, RUAN (RPH BS)
Entity type:Individual
Prefix:
First Name:RUAN
Middle Name:
Last Name:KENDALL
Suffix:
Gender:F
Credentials:RPH BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 HARRIS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:MS
Mailing Address - Zip Code:38647-9216
Mailing Address - Country:US
Mailing Address - Phone:662-224-3532
Mailing Address - Fax:662-224-9111
Practice Address - Street 1:15917 BOUNDARY DR
Practice Address - Street 2:HWY 5
Practice Address - City:ASHLAND
Practice Address - State:MS
Practice Address - Zip Code:38603
Practice Address - Country:US
Practice Address - Phone:662-224-8922
Practice Address - Fax:662-224-9111
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST08057183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist