Provider Demographics
NPI:1942521794
Name:PENDERGRAFT, NANCY L (RPH)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:PENDERGRAFT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4117 KITSAP WAY
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-2449
Mailing Address - Country:US
Mailing Address - Phone:360-479-2415
Mailing Address - Fax:360-479-8571
Practice Address - Street 1:4117 KITSAP WAY
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-2449
Practice Address - Country:US
Practice Address - Phone:360-479-2415
Practice Address - Fax:360-479-8571
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00009012183500000X
CA38971183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist