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General NPI Number Information
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NPI Number | 1770250631
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Entity Type | Individual
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Provider Name | KENNEDY HO PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/26/2021
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Last Update Date | 08/26/2021
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Provider Practice Location Address
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Address Line | 8160 DAY CREEK BLVD
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-9329
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Country | US
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Telephone | 321-890-3346
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Fax |
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Provider Business Mailing Address
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Address Line | 26000 W LUGONIA AVE APT 2418
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City | REDLANDS
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State | CA
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Zip | 92374-5108
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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 | PS61095
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License Number State | FL
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