Healthcare Provider Details

I. General information

NPI: 1487936233
Provider Name (Legal Business Name): CHRISTINE J KENNEDY P.D.,PH.D., R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5373 PEACHTREE IND BLVD
CHAMBLEE GA
30341-2139
US

IV. Provider business mailing address

5373 PEACHTREE IND BLVD
CHAMBLEE GA
30341-2139
US

V. Phone/Fax

Practice location:
  • Phone: 678-547-1672
  • Fax:
Mailing address:
  • Phone: 678-547-1672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH023405
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: