Provider Demographics
NPI:1285800862
Name:KENNEDY, BEVERLY A (RPH)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:A
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SOUTH 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT LAKE
Mailing Address - State:PA
Mailing Address - Zip Code:16316
Mailing Address - Country:US
Mailing Address - Phone:814-382-2380
Mailing Address - Fax:814-382-2818
Practice Address - Street 1:100 S THIRD ST
Practice Address - Street 2:
Practice Address - City:CONNEAUT LAKE
Practice Address - State:PA
Practice Address - Zip Code:16316
Practice Address - Country:US
Practice Address - Phone:814-382-2380
Practice Address - Fax:814-382-2818
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP042593L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist