Provider Demographics
NPI:1467753012
Name:KENNEDY, LARRY A (RPH)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:A
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 1:6360 E GOLF LINKS RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85730-1058
Mailing Address - Country:US
Mailing Address - Phone:520-514-9567
Mailing Address - Fax:
Practice Address - Street 1:6360 E GOLF LINKS RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85730-1058
Practice Address - Country:US
Practice Address - Phone:520-514-9567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-13
Last Update Date:2010-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6739183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist