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General NPI Number Information
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NPI Number | 1245832880
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Entity Type | Individual
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Provider Name | JACQUELYN MALIA KENNEDY
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Gender | Female
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Dates
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Enumeration Date | 11/09/2020
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Last Update Date | 04/12/2025
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Provider Practice Location Address
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Address Line | 232 SHIRLEY DR
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63701-8478
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Country | US
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Telephone | 573-332-0329
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Fax |
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Provider Business Mailing Address
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Address Line | 232 SHIRLEY DR
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63701-8478
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Country | US
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Telephone | 573-332-0329
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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 | 2015020743
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License Number State | MO
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