Provider Demographics
NPI:1508645318
Name:RUSSELL, KENDALL R (RPH)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:R
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 E JACQUELINE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4314
Mailing Address - Country:US
Mailing Address - Phone:417-894-3540
Mailing Address - Fax:417-336-2772
Practice Address - Street 1:1232 BRANSON HILLS PKWY STE 205
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-4188
Practice Address - Country:US
Practice Address - Phone:417-336-4701
Practice Address - Fax:417-336-2772
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-22
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044505183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist