Provider Demographics
NPI:1366880148
Name:KINKEAD, WENDY SUE (RPH)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:SUE
Last Name:KINKEAD
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 1:105 S ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65240-1303
Mailing Address - Country:US
Mailing Address - Phone:573-682-2155
Mailing Address - Fax:573-682-2708
Practice Address - Street 1:105 S ALLEN ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:MO
Practice Address - Zip Code:65240-1303
Practice Address - Country:US
Practice Address - Phone:573-682-2155
Practice Address - Fax:573-682-2708
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0419931835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist