Healthcare Provider Details

I. General information

NPI: 1881977627
Provider Name (Legal Business Name): JOHN W KENNEDY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 W OWEN K GARRIOTT RD
ENID OK
73701-5439
US

IV. Provider business mailing address

505 SOUTH JEFFERSON PO BOX 475
ARNETT OK
73832
US

V. Phone/Fax

Practice location:
  • Phone: 580-237-3151
  • Fax: 580-237-2564
Mailing address:
  • Phone: 580-216-2759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12527
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: