Provider Demographics
NPI:1548838949
Name:DAVIS, KENDRA L (CPHT, RPHT)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CPHT, RPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13990 BARTRAM PARK BLVD UNIT 701
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5549
Mailing Address - Country:US
Mailing Address - Phone:786-910-8938
Mailing Address - Fax:904-296-5871
Practice Address - Street 1:4203 BELFORT RD STE 215
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1416
Practice Address - Country:US
Practice Address - Phone:904-296-5870
Practice Address - Fax:904-296-5871
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL42683183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician