Provider Demographics
NPI:1609044577
Name:KENDALL, PATRICK MICHAEL
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:MICHAEL
Last Name:KENDALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 N SHIAWASSEE ST STE E
Mailing Address - Street 2:
Mailing Address - City:CORUNNA
Mailing Address - State:MI
Mailing Address - Zip Code:48817-1444
Mailing Address - Country:US
Mailing Address - Phone:989-720-4295
Mailing Address - Fax:
Practice Address - Street 1:211 N SHIAWASSEE ST STE E
Practice Address - Street 2:
Practice Address - City:CORUNNA
Practice Address - State:MI
Practice Address - Zip Code:48817-1444
Practice Address - Country:US
Practice Address - Phone:989-720-4295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2021-12-01
Deactivation Date:2021-04-22
Deactivation Code:
Reactivation Date:2021-12-01
Provider Licenses
StateLicense IDTaxonomies
MI5302034762183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist