Provider Demographics
NPI:1578278669
Name:SAULSBERRY, KENNEDY JAI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KENNEDY
Middle Name:JAI
Last Name:SAULSBERRY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MRS
Other - First Name:KENNEDY
Other - Middle Name:JAI
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1512 SHERMAN PL APT 8
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-7833
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5822 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-3712
Practice Address - Country:US
Practice Address - Phone:323-750-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87392183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist