Individual
KENDRA KARMEL FITZGERALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2543 HOOD AVE, OVERLAND, MO 63114-3259
(314) 736-1093
(314) 736-1097
Mailing address
2543 HOOD AVE, OVERLAND, MO 63114-3259
(314) 736-1093
(314) 736-1097
Taxonomy
Speciality
Code
Description
License number
State
1835P2201X
Ambulatory Care Pharmacist
Primary
1752
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26263572
MISSOURI TAX
MO
01
—
844751516
FEDERAL IDENTIFICATION NUMBER
MO
Enumeration date
11/05/2020
Last updated
11/05/2020
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