Provider Demographics
NPI:1053773093
Name:LI, KENDALL RAE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:KENDALL
Middle Name:RAE
Last Name:LI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 KINGSLEY WAY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-4628
Mailing Address - Country:US
Mailing Address - Phone:608-310-9922
Mailing Address - Fax:608-442-8490
Practice Address - Street 1:3250 KINGSLEY WAY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-4628
Practice Address - Country:US
Practice Address - Phone:608-310-9922
Practice Address - Fax:608-442-8490
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16732-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist