Provider Demographics
NPI:1932504008
Name:BRENTON, KENDALL JEANNE (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:KENDALL
Middle Name:JEANNE
Last Name:BRENTON
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 1:305 SUSAN DR
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-9482
Mailing Address - Country:US
Mailing Address - Phone:208-871-0041
Mailing Address - Fax:
Practice Address - Street 1:400 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-1931
Practice Address - Country:US
Practice Address - Phone:208-871-0041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-30
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60556897183500000X
IDP7357183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist