Provider Demographics
NPI:1043939689
Name:VANNORSDALL, KADEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KADEE
Middle Name:
Last Name:VANNORSDALL
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 1:1540 FROOM RANCH WAY
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-7211
Mailing Address - Country:US
Mailing Address - Phone:805-541-7028
Mailing Address - Fax:
Practice Address - Street 1:1540 FROOM RANCH WAY
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-7211
Practice Address - Country:US
Practice Address - Phone:805-541-7028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86612183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist