Provider Demographics
NPI:1033886643
Name:MERICAL, KENNEDY HART (PHARMD)
Entity Type:Individual
Prefix:
First Name:KENNEDY
Middle Name:HART
Last Name:MERICAL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 NE DELAWARE AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-6691
Mailing Address - Country:US
Mailing Address - Phone:515-964-8550
Mailing Address - Fax:515-963-4055
Practice Address - Street 1:107 NE DELAWARE AVE STE 6
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-6691
Practice Address - Country:US
Practice Address - Phone:515-964-8550
Practice Address - Fax:515-963-4055
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24207183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist