Individual
JACK A. KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
4924 SOMERS AVE, TREVOSE, PA 19053-4863
(215) 322-2265
Mailing address
4924 SOMERS AVE, TREVOSE, PA 19053-4863
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP444283
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RPI004193
IMMUNIZER LICENSE
PA
Enumeration date
03/03/2012
Last updated
03/03/2012
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