Provider Demographics
NPI:1497330492
Name:ELAM, KENDALL CHRISTOPHER (PHARMACY TECH)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:CHRISTOPHER
Last Name:ELAM
Suffix:
Gender:M
Credentials:PHARMACY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 TOWNE CENTRE BLVD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-5620
Mailing Address - Country:US
Mailing Address - Phone:517-487-9161
Mailing Address - Fax:517-487-9163
Practice Address - Street 1:3225 TOWNE CENTRE BLVD BLDG 3225
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-5620
Practice Address - Country:US
Practice Address - Phone:517-487-9161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303008000156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist