Provider Demographics
NPI:1619157518
Name:KENNEDY, DAVID RICHARD (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:RICHARD
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 1:174 BAUMAN RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3804
Mailing Address - Country:US
Mailing Address - Phone:716-632-3821
Mailing Address - Fax:
Practice Address - Street 1:8530 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2836
Practice Address - Country:US
Practice Address - Phone:716-688-0641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033008183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist