Healthcare Provider Details

I. General information

NPI: 1063336550
Provider Name (Legal Business Name): LYNN MARIE KENNY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 FRONT ST
ELMER NJ
08318-2101
US

IV. Provider business mailing address

1066 RAINBOW CIR
PITTSGROVE NJ
08318-9166
US

V. Phone/Fax

Practice location:
  • Phone: 856-363-1557
  • Fax:
Mailing address:
  • Phone: 609-319-2976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02205600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: