Provider Demographics
NPI:1679917850
Name:MANIGAULT, KENDRA (PHARMD)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:MANIGAULT
Suffix:
Gender:F
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:PO BOX 984
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-0984
Mailing Address - Country:US
Mailing Address - Phone:843-312-9190
Mailing Address - Fax:
Practice Address - Street 1:3001 MERCER UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4115
Practice Address - Country:US
Practice Address - Phone:843-312-9190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0254941835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist