Provider Demographics
NPI:1336633601
Name:BABCOCK, KENDRA JEAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:JEAN
Last Name:BABCOCK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:KENDRA
Other - Middle Name:JEAN
Other - Last Name:ERNSTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:8441 WAYZATA BLVD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1344
Mailing Address - Country:US
Mailing Address - Phone:952-658-5487
Mailing Address - Fax:
Practice Address - Street 1:8441 WAYZATA BLVD
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55426
Practice Address - Country:US
Practice Address - Phone:952-658-5487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN123752183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist