1366690596 NPI number — KENDRA MCCALLIE LIMHP, LLC

Table of content: ERIKA MARIE SANCHEZ AYALA PHARMD (NPI 1831894534)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366690596 NPI number — KENDRA MCCALLIE LIMHP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENDRA MCCALLIE LIMHP, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366690596
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
535 FORTUNE DR
Provider Second Line Business Mailing Address:
SUITE 130
Provider Business Mailing Address City Name:
PAPILLION
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68046-3428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-689-6135
Provider Business Mailing Address Fax Number:
402-916-9757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
535 FORTUNE DR.
Provider Second Line Business Practice Location Address:
STE 130
Provider Business Practice Location Address City Name:
PAPILLION
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-689-6135
Provider Business Practice Location Address Fax Number:
402-916-9757
Provider Enumeration Date:
08/29/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCCALLIE
Authorized Official First Name:
KENDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
402-689-6135

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  1079 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)