Provider Demographics
NPI:1578875720
Name:KENNEDY, MARCIA PHILOPENA (RPH)
Entity Type:Individual
Prefix:MISS
First Name:MARCIA
Middle Name:PHILOPENA
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 GARDNERS CIR
Mailing Address - Street 2:SUITE 122
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-5467
Mailing Address - Country:US
Mailing Address - Phone:843-795-7976
Mailing Address - Fax:843-795-4336
Practice Address - Street 1:130 GARDNERS CIR
Practice Address - Street 2:SUITE 122
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-5467
Practice Address - Country:US
Practice Address - Phone:843-795-7976
Practice Address - Fax:843-795-4336
Is Sole Proprietor?:No
Enumeration Date:2010-07-03
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist