Individual
KENDALL MARK VAN TYLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
US HWY 491 NORTH, SHIPROCK, NM 87420
(505) 368-6401
(505) 368-6431
Mailing address
PO BOX 160, SHIPROCK, NM 87420-0160
(505) 368-6401
(505) 368-6431
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
15747
AZ
Other
Enumeration date
12/22/2006
Last updated
07/08/2007
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