Provider Demographics
NPI:1225468986
Name:KENNEDY, ROBERT EMERSON (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:EMERSON
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6748 MORNINGSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-2652
Mailing Address - Country:US
Mailing Address - Phone:216-513-8629
Mailing Address - Fax:
Practice Address - Street 1:6300 PEARL RD
Practice Address - Street 2:
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3041
Practice Address - Country:US
Practice Address - Phone:440-886-0775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-17
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03232869183500000X
AZS020257183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist