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NPI Code Detail

MEDICARE: CYRILLA M KENNEDY PHARM D

MEDICARE: CYRILLA M KENNEDY PHARM D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist36396TX
21835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist36396TX

General Provider Information

NPI Number : 1356665707
Entity Type Code : Individual
Provider Name (Legal Business Name) : CYRILLA M KENNEDY PHARM D
Provider Business Mailing Address
First Line : 8120 S COCKRELL HILL RD
Second Line :
City : DALLAS
State : TX
Zip : 75236-9668
Country : US
Telephone Number : 972-283-1473
Fax Number :
Provider Business Practice Location Address
First Line : 8120 S COCKRELL HILL RD
Second Line :
City : DALLAS
State : TX
Zip : 75236-9668
Country : US
Telephone Number : 972-283-1473
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2010
Last Update Date : 03/15/2010

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