Provider Demographics
NPI:1669112660
Name:STRAY, KENNEDY LYNN (PHARMD)
Entity type:Individual
Prefix:
First Name:KENNEDY
Middle Name:LYNN
Last Name:STRAY
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 1:15925 ALGOMA AVE NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49319-8867
Mailing Address - Country:US
Mailing Address - Phone:231-519-1695
Mailing Address - Fax:
Practice Address - Street 1:1706 N SANDHILLS BLVD
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-2338
Practice Address - Country:US
Practice Address - Phone:910-944-1502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5351013292390200000X
NC31547183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program