Provider Demographics
NPI:1245513639
Name:CHIEU-KENNEDY, CAROLINE T
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:T
Last Name:CHIEU-KENNEDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-4534
Mailing Address - Country:US
Mailing Address - Phone:561-848-6464
Mailing Address - Fax:
Practice Address - Street 1:2501 BROADWAY
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-4534
Practice Address - Country:US
Practice Address - Phone:561-848-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35953183500000X
MAPH24460183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist