Provider Demographics
NPI:1548570419
Name:DEAL, KENDRA OLIVIA (CPHT)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:OLIVIA
Last Name:DEAL
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14405 RIO BONITO RD
Mailing Address - Street 2:APT 483
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-1542
Mailing Address - Country:US
Mailing Address - Phone:832-349-0567
Mailing Address - Fax:
Practice Address - Street 1:14405 RIO BONITO RD
Practice Address - Street 2:APT 483
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-1542
Practice Address - Country:US
Practice Address - Phone:832-349-0567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX184694183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician