Provider Demographics
NPI:1114062072
Name:KENDALLS REXALL PHARMACY INC
Entity Type:Organization
Organization Name:KENDALLS REXALL PHARMACY INC
Other - Org Name:KENDALLS HOME MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-692-4461
Mailing Address - Street 1:223 6TH STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006
Mailing Address - Country:US
Mailing Address - Phone:605-692-4461
Mailing Address - Fax:605-692-0845
Practice Address - Street 1:223 6TH ST
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006
Practice Address - Country:US
Practice Address - Phone:605-692-4461
Practice Address - Fax:605-692-0845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN361882000OtherMINNESOTA HEALTH CARE
4998872OtherWELLMARK BLUE CROSS BLUE
SD9161180Medicaid
=========OtherDAKOTA CARE
=========OtherDAKOTA CARE