MEDICARE: DR. KENNEDY FAYE HOSTETLER PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	26030336A	IN

General Provider Information

NPI Number	:	1588342372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNEDY FAYE HOSTETLER PHARMD

Provider Business Mailing Address
First Line	:	18334 LAKE WINDS DR
Second Line	:
City	:	WESTFIELD
State	:	IN
Zip	:	46074-6316
Country	:	US
Telephone Number	:	317-879-6971
Fax Number	:

Provider Business Practice Location Address
First Line	:	8801 N MERIDIAN ST STE 108
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-2353
Country	:	US
Telephone Number	:	317-846-6654
Fax Number	:	317-846-3038

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2023
Last Update Date	:	07/11/2023

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