Healthcare Provider Details

I. General information

NPI: 1962736835
Provider Name (Legal Business Name): JOHN LOWRY KENNEDY PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 09/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 E BROAD ST
STATESVILLE NC
28625-4306
US

IV. Provider business mailing address

620 BERKSHIRE DR
STATESVILLE NC
28677-6020
US

V. Phone/Fax

Practice location:
  • Phone: 704-872-8131
  • Fax:
Mailing address:
  • Phone: 704-873-6297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4799
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: