Healthcare Provider Details

I. General information

NPI: 1891027652
Provider Name (Legal Business Name): SELENA A KENNADAY PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2010
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 FUN CENTER DRIVE WALMART PHARMACY
SURF CITY NC
28445
US

IV. Provider business mailing address

3475 PARKWAY VILLAGE CIR
WINSTON SALEM NC
27127-6857
US

V. Phone/Fax

Practice location:
  • Phone: 910-803-6003
  • Fax: 910-803-6004
Mailing address:
  • Phone: 336-771-9711
  • Fax: 336-771-9710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21304
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number053530
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: