Provider Demographics
NPI:1649748161
Name:KENNEDY, ANDREW RYAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:RYAN
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337-6989
Mailing Address - Country:US
Mailing Address - Phone:308-432-6995
Mailing Address - Fax:
Practice Address - Street 1:510 LINDEN ST
Practice Address - Street 2:
Practice Address - City:CHADRON
Practice Address - State:NE
Practice Address - Zip Code:69337-6989
Practice Address - Country:US
Practice Address - Phone:308-432-6995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21054183500000X
NE16864183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO21054OtherSTATE BOARD OF PHARMACY
NE16864OtherNEBRASKA BOARD OF PHARMACY