Provider Demographics
NPI:1689120412
Name:KILBOURNE, KENDALL KEITH (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:KEITH
Last Name:KILBOURNE
Suffix:
Gender:M
Credentials:PHARMACIST
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 796
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:KY
Mailing Address - Zip Code:40456-0796
Mailing Address - Country:US
Mailing Address - Phone:606-256-3447
Mailing Address - Fax:
Practice Address - Street 1:410 RICHMOND
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:KY
Practice Address - Zip Code:40456-0796
Practice Address - Country:US
Practice Address - Phone:606-256-3447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011078183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist