Provider Demographics
NPI:1225114259
Name:KENNEY, ELLEN J (RPH, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:J
Last Name:KENNEY
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 CHURCH HILL RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-8226
Mailing Address - Country:US
Mailing Address - Phone:207-629-9028
Mailing Address - Fax:
Practice Address - Street 1:1 VA CENTER
Practice Address - Street 2:TOGUS VA MEDICAL CENTER
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330
Practice Address - Country:US
Practice Address - Phone:207-623-8411
Practice Address - Fax:207-623-5731
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044526183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist