Provider Demographics
NPI:1881296705
Name:KENNERY, DAVID FRANCIS
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:FRANCIS
Last Name:KENNERY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 PROVIDENCE HWY
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-4231
Mailing Address - Country:US
Mailing Address - Phone:508-668-5959
Mailing Address - Fax:508-668-5117
Practice Address - Street 1:550 PROVIDENCE HWY
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-4231
Practice Address - Country:US
Practice Address - Phone:508-668-5959
Practice Address - Fax:508-668-5117
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH25197183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty