Provider Demographics
NPI:1639806888
Name:LITTLEFIELD, KENDALL MARIE
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:MARIE
Last Name:LITTLEFIELD
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 1:235 N CHESTNUT WOOD LN APT 314
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46725-0015
Mailing Address - Country:US
Mailing Address - Phone:219-476-6365
Mailing Address - Fax:
Practice Address - Street 1:618 S MAIN STREET
Practice Address - Street 2:P.O. BOX 214
Practice Address - City:NORTH WEBSTER
Practice Address - State:IN
Practice Address - Zip Code:46555-3702
Practice Address - Country:US
Practice Address - Phone:574-457-5518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26030828A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist