Provider Demographics
NPI:1275998890
Name:KENNEDY PHARMACY
Entity Type:Organization
Organization Name:KENNEDY PHARMACY
Other - Org Name:KENNEDY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:HEMANT
Authorized Official - Middle Name:H
Authorized Official - Last Name:VORA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:732-515-9500
Mailing Address - Street 1:1 LINCOLN HWY
Mailing Address - Street 2:STORE # 3
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3962
Mailing Address - Country:US
Mailing Address - Phone:732-515-9500
Mailing Address - Fax:732-515-9503
Practice Address - Street 1:1 LINCOLN HWY
Practice Address - Street 2:STORE # 3
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3962
Practice Address - Country:US
Practice Address - Phone:732-515-9500
Practice Address - Fax:732-515-9503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-26
Last Update Date:2018-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
APPLICATION IN PROCE3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7560220001Medicare NSC