Healthcare Provider Details

I. General information

NPI: 1649748161
Provider Name (Legal Business Name): ANDREW RYAN KENNEDY PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2018
Last Update Date: 10/24/2021
Certification Date: 10/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 LINDEN ST
CHADRON NE
69337-6989
US

IV. Provider business mailing address

510 LINDEN ST
CHADRON NE
69337-6989
US

V. Phone/Fax

Practice location:
  • Phone: 308-432-6995
  • Fax:
Mailing address:
  • Phone: 308-432-6995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21054
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16864
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: