Kendal L Pedersen

Primary specialty

PharmacistTaxonomy code 183500000X

License

11268 Issued in NV

Practice address

5500 Boulder Hwy
Las Vegas, NV 89122-6010

Phone

(702) 435-7339

Fax

(702) 352-1082

NPI assigned

Nov 12, 2009

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1257984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257984000000",
    "number": "1790012680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 BOULDER HWY",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891226010",
            "telephone_number": "702-435-7339",
            "fax_number": "702-352-1082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5500 BOULDER HWY",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891226010",
            "telephone_number": "702-435-7339",
            "fax_number": "702-352-1082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSEN",
        "first_name": "KENDAL",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-11-12",
        "last_updated": "2009-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NV",
            "license": "11268",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OR",
            "license": "9065",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pecos Surgery Center LLC
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• Suneal Gopal Peddada, DO
• Abbigail Peddieson, MFT-LICENSED INTERN
• Robert Pedersen
• Stephen Pedersen, HIGH SCHOOL DIPLOMA
• Anita G Pederson
• Christopher A Pederson, M.D., M.P.H.
• Pediatric Behavior Management Professionals

• Pharmacist in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Pharmacist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.