Provider Demographics
NPI:1073221073
Name:MANIACI, KENDRA (RPH)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:MANIACI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N33W29285 MILLRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-3264
Mailing Address - Country:US
Mailing Address - Phone:262-442-9046
Mailing Address - Fax:
Practice Address - Street 1:7701 METROPOLIS DR STE 20B
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-3125
Practice Address - Country:US
Practice Address - Phone:512-200-3650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71548183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist