Provider Demographics
NPI:1750609095
Name:KENNEY, PATRICIA A (RPH, MHA)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:KENNEY
Suffix:
Gender:F
Credentials:RPH, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 ALLEN AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3728
Mailing Address - Country:US
Mailing Address - Phone:207-797-4351
Mailing Address - Fax:207-878-3135
Practice Address - Street 1:365 ALLEN AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3728
Practice Address - Country:US
Practice Address - Phone:207-797-4351
Practice Address - Fax:207-878-3135
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4150183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist