Provider Demographics
NPI:1083626568
Name:MCKENNA, ENDA LOUIS (RPH,MBA,PHARMD)
Entity Type:Individual
Prefix:MR
First Name:ENDA
Middle Name:LOUIS
Last Name:MCKENNA
Suffix:
Gender:M
Credentials:RPH,MBA,PHARMD
Other - Prefix:MR
Other - First Name:LOUIS
Other - Middle Name:ENDA
Other - Last Name:MCKENNA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH,MBA, PHARMD
Mailing Address - Street 1:10535 HOSPITAL WAY
Mailing Address - Street 2:
Mailing Address - City:MATHER
Mailing Address - State:CA
Mailing Address - Zip Code:95655-4200
Mailing Address - Country:US
Mailing Address - Phone:916-366-5321
Mailing Address - Fax:
Practice Address - Street 1:10535 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:MATHER
Practice Address - State:CA
Practice Address - Zip Code:95655-4200
Practice Address - Country:US
Practice Address - Phone:916-366-5321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH16690183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist