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General NPI Number Information
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NPI Number | 1356483184
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Entity Type | Individual
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Provider Name | TRAVIS J KENNEDY PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 710 CENTER STREET
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City | COLUMBUS
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State | GA
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Zip | 31901
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Country | US
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Telephone | 706-571-1396
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Fax |
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Provider Business Mailing Address
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Address Line | 1017 KING PLACE DR
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City | COLUMBUS
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State | GA
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Zip | 31904-2635
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Country | US
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Telephone | 706-653-9648
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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 | 019416
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License Number State | GA
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