Provider Demographics
NPI:1588342372
Name:HOSTETLER, KENNEDY FAYE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KENNEDY
Middle Name:FAYE
Last Name:HOSTETLER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18334 LAKE WINDS DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-6316
Mailing Address - Country:US
Mailing Address - Phone:317-879-6971
Mailing Address - Fax:
Practice Address - Street 1:8801 N MERIDIAN ST STE 108
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2353
Practice Address - Country:US
Practice Address - Phone:317-846-6654
Practice Address - Fax:317-846-3038
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26030336A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist