Provider Demographics
NPI:1871730077
Name:KENNEDY, ANDREW JAMES III (RPH)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:JAMES
Last Name:KENNEDY
Suffix:III
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 1:82 LIBORIO LN
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-7711
Mailing Address - Country:US
Mailing Address - Phone:609-306-6550
Mailing Address - Fax:
Practice Address - Street 1:82 LIBORIO LN
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-7711
Practice Address - Country:US
Practice Address - Phone:609-306-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-10
Last Update Date:2009-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA10003686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist