Provider Demographics
NPI:1164718557
Name:KENNEDY, SARAH MICHELLE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:MICHELLE
Last Name:KENNEDY
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 1:555 BULLSBORO DR
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-1045
Mailing Address - Country:US
Mailing Address - Phone:770-502-9360
Mailing Address - Fax:770-502-9360
Practice Address - Street 1:555 BULLSBORO DR
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1045
Practice Address - Country:US
Practice Address - Phone:770-502-9360
Practice Address - Fax:770-502-9360
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40691183500000X
GARPH025769183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist