Provider Demographics
NPI:1013302934
Name:KENNEY, JACOB WILSON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:WILSON
Last Name:KENNEY
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 1:459 N BROADNAX ST
Mailing Address - Street 2:
Mailing Address - City:DADEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36853-2108
Mailing Address - Country:US
Mailing Address - Phone:256-825-4242
Mailing Address - Fax:256-825-5034
Practice Address - Street 1:459 N BROADNAX ST
Practice Address - Street 2:
Practice Address - City:DADEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36853-2108
Practice Address - Country:US
Practice Address - Phone:256-825-4242
Practice Address - Fax:256-825-5034
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist