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General NPI Number Information
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NPI Number | 1023487881
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Entity Type | Individual
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Provider Name | LARRY KENNEDY PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 09/22/2015
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Last Update Date | 09/22/2015
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Provider Practice Location Address
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Address Line | 339 S MAIN ST
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City | STAR
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State | NC
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Zip | 27356-7765
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Country | US
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Telephone | 910-428-4422
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Fax | 910-428-4220
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Provider Business Mailing Address
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Address Line | P O BOX 279 240 COTTON CREEK ROAD
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City | STAR
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State | NC
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Zip | 27356-9999
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 4910
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License Number State | NC
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