Individual
DR. BLAKE THOMAS KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
826 N PINE ST, ISHPEMING, MI 49849-1435
(269) 967-5121
Mailing address
826 N PINE ST, ISHPEMING, MI 49849-1435
(269) 967-5121
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302041893
MI
Other
Enumeration date
12/19/2020
Last updated
12/19/2020
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