Provider Demographics
NPI:1104361773
Name:EDNACOT, KENDRA (DOCTOR OF PHARMACY)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:EDNACOT
Suffix:
Gender:F
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8510 BALBOA BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-3583
Mailing Address - Country:US
Mailing Address - Phone:818-672-4784
Mailing Address - Fax:
Practice Address - Street 1:8510 BALBOA BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-3583
Practice Address - Country:US
Practice Address - Phone:818-672-4784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist