Provider Demographics
NPI:1184939530
Name:PURDUM, KENDRA GINGERICH (PHARMD)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:GINGERICH
Last Name:PURDUM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:FAYE
Other - Last Name:GINGERICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:500 WEST BROADWAY
Mailing Address - Street 2:INPATIENT PHARMACY
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801
Mailing Address - Country:US
Mailing Address - Phone:406-329-0321
Mailing Address - Fax:
Practice Address - Street 1:500 W BROADWAY ST
Practice Address - Street 2:PROVIDENCE ST. PATRICK HOSPITAL
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801
Practice Address - Country:US
Practice Address - Phone:506-329-0321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6273183500000X
MTPHA-PHA-LIC-62731835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No183500000XPharmacy Service ProvidersPharmacist