Provider Demographics
NPI:1013207513
Name:KENDALL, ROSS WAID (PHARMD)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:WAID
Last Name:KENDALL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 PHYSICIANS BLVD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-7404
Mailing Address - Country:US
Mailing Address - Phone:704-454-5135
Mailing Address - Fax:704-454-5086
Practice Address - Street 1:4310 PHYSICIANS BLVD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-7404
Practice Address - Country:US
Practice Address - Phone:704-454-5135
Practice Address - Fax:704-454-5086
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18240183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist