Provider Demographics
NPI:1649855636
Name:TOM, KENDYL (RPH)
Entity type:Individual
Prefix:
First Name:KENDYL
Middle Name:
Last Name:TOM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1334 E CHANDLER BLVD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-6267
Mailing Address - Country:US
Mailing Address - Phone:480-283-0119
Mailing Address - Fax:
Practice Address - Street 1:1334 E CHANDLER BLVD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-6267
Practice Address - Country:US
Practice Address - Phone:480-283-0119
Practice Address - Fax:480-283-2775
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS027239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZI024896OtherPHARMACIST INTERN