Provider Demographics
NPI:1639598956
Name:KENNEDY, BRANDEN FRANCIS O'BRIEN
Entity Type:Individual
Prefix:
First Name:BRANDEN
Middle Name:FRANCIS O'BRIEN
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 DOCK ST
Mailing Address - Street 2:UNIT 311
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3201
Mailing Address - Country:US
Mailing Address - Phone:618-698-9491
Mailing Address - Fax:
Practice Address - Street 1:1821 DOCK ST
Practice Address - Street 2:UNIT 311
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3201
Practice Address - Country:US
Practice Address - Phone:618-698-9491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60472076183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist