Healthcare Provider Details

I. General information

NPI: 1235685769
Provider Name (Legal Business Name): KIERAN FENNELL RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2016
Last Update Date: 08/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 WINDSOR DR
WHITMAN MA
02382-1049
US

IV. Provider business mailing address

29 WINDSOR DR
WHITMAN MA
02382-1049
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-6785
  • Fax: 617-414-1588
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPH24141
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: