Provider Demographics
NPI:1720560188
Name:KENNEDY, VERONICA MONIQUE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:MONIQUE
Last Name:KENNEDY
Suffix:
Gender:F
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:P.O. BOX 134
Mailing Address - Street 2:
Mailing Address - City:REKLAW
Mailing Address - State:TX
Mailing Address - Zip Code:75784
Mailing Address - Country:US
Mailing Address - Phone:903-714-9384
Mailing Address - Fax:
Practice Address - Street 1:1522 WEST FRANK
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904
Practice Address - Country:US
Practice Address - Phone:936-630-3799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-02
Last Update Date:2018-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43625183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist