Provider Demographics
NPI:1578020665
Name:RENDER, KANDON PRICE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KANDON
Middle Name:PRICE
Last Name:RENDER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 WHITLOCK AVE NW STE G-1
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-3174
Mailing Address - Country:US
Mailing Address - Phone:770-514-1414
Mailing Address - Fax:
Practice Address - Street 1:660 WHITLOCK AVE NW STE G-1
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3174
Practice Address - Country:US
Practice Address - Phone:770-514-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH030606183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist