Healthcare Provider Details

I. General information

NPI: 1477475093
Provider Name (Legal Business Name): KENNEDY HOULE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 S STEPHENSON AVE
IRON MOUNTAIN MI
49801-3637
US

IV. Provider business mailing address

N17754 44 ROAD
HERMANSVILLE MI
49847
US

V. Phone/Fax

Practice location:
  • Phone: 906-774-5413
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302413852
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: