Provider Demographics
NPI:1942694724
Name:HUTCHINS, KENDELL LEROY (PHARMD)
Entity Type:Individual
Prefix:
First Name:KENDELL
Middle Name:LEROY
Last Name:HUTCHINS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALTURAS
Mailing Address - State:CA
Mailing Address - Zip Code:96101-4084
Mailing Address - Country:US
Mailing Address - Phone:530-233-4884
Mailing Address - Fax:530-233-4449
Practice Address - Street 1:120 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ALTURAS
Practice Address - State:CA
Practice Address - Zip Code:96101-4084
Practice Address - Country:US
Practice Address - Phone:530-233-4884
Practice Address - Fax:530-233-4449
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2189183500000X
CA69973183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist