MEDICARE: DANIEL L KENNEDY RPH

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
1	183500000X	Pharmacist	8492	OR

General Provider Information

NPI Number	:	1548211873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL L KENNEDY RPH

Provider Business Mailing Address
First Line	:	2617 SE SWAIN AVE
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97267-3818
Country	:	US
Telephone Number	:	503-659-2050
Fax Number	:

Provider Business Practice Location Address
First Line	:	5050 NE HOYT ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97213-2956
Country	:	US
Telephone Number	:	503-215-6296
Fax Number	:	503-215-6459

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	07/08/2007

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