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General NPI Number Information
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NPI Number | 1346851425
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Entity Type | Individual
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Provider Name | TYLER KENNEDY PHARM D
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Gender | Male
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Dates
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Enumeration Date | 08/12/2020
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Last Update Date | 08/12/2020
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Provider Practice Location Address
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Address Line | 138 2ND AVE N
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City | PARK FALLS
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State | WI
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Zip | 54552-1299
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Country | US
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Telephone | 715-762-3283
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Fax |
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Provider Business Mailing Address
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Address Line | N15588 WAGNER RD
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City | PARK FALLS
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State | WI
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Zip | 54552-8259
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Country | US
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Telephone | 715-661-3262
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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 | 19551-40
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License Number State | WI
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