Provider Demographics
NPI:1295599785
Name:KENNY, DEVIN FITZGERALD (PHARMD)
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:FITZGERALD
Last Name:KENNY
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 1:3300 COTTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-1601
Mailing Address - Country:US
Mailing Address - Phone:215-624-3903
Mailing Address - Fax:215-709-2294
Practice Address - Street 1:3300 COTTMAN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1601
Practice Address - Country:US
Practice Address - Phone:215-624-3903
Practice Address - Fax:215-709-2294
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP457973183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist