Provider Demographics
NPI:1558549238
Name:KENDIS, ELINA M (RPH)
Entity Type:Individual
Prefix:MS
First Name:ELINA
Middle Name:M
Last Name:KENDIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WORTH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4008
Mailing Address - Country:US
Mailing Address - Phone:212-571-4621
Mailing Address - Fax:212-571-4625
Practice Address - Street 1:111 WORTH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4008
Practice Address - Country:US
Practice Address - Phone:212-571-4621
Practice Address - Fax:212-571-4625
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049456183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02783315Medicaid