Provider Demographics
NPI:1861910259
Name:KENDRICK, CHRISTA DANAE (PHARMD)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:DANAE
Last Name:KENDRICK
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 1:1667 GLENWAY LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-4121
Mailing Address - Country:US
Mailing Address - Phone:304-633-6537
Mailing Address - Fax:
Practice Address - Street 1:505 20TH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25703-1510
Practice Address - Country:US
Practice Address - Phone:304-522-1035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0007921183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist