Provider Demographics
NPI:1184237802
Name:PATRICELLI, KENDALL PAIGE
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:PAIGE
Last Name:PATRICELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MAE LN
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-8943
Mailing Address - Country:US
Mailing Address - Phone:724-415-7612
Mailing Address - Fax:
Practice Address - Street 1:103 TRANSIT DR
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-2659
Practice Address - Country:US
Practice Address - Phone:724-415-7612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP454661183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist