Provider Demographics
NPI:1235685769
Name:FENNELL, KIERAN (RPH)
Entity type:Individual
Prefix:
First Name:KIERAN
Middle Name:
Last Name:FENNELL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:WHITMAN
Mailing Address - State:MA
Mailing Address - Zip Code:02382-1049
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:29 WINDSOR DR
Practice Address - Street 2:
Practice Address - City:WHITMAN
Practice Address - State:MA
Practice Address - Zip Code:02382-1049
Practice Address - Country:US
Practice Address - Phone:617-638-6785
Practice Address - Fax:617-414-1588
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH241411835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care