Active NPI
Mary Elizabeth Kennedy
- Pharmacy Technician
- San Antonio, TX
National Provider Identifier
1124617550
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy Technician
- License
- 173021
- Practice address
- 10718 Potranco Rd
San Antonio, TX 78251-3312 - Phone
- (210) 681-2301
- NPI assigned
- Jan 11, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy Technician | 183700000X | 173021 | TX | Primary |
Addresses
Primary practice location
10718 Potranco Rd
San Antonio, TX 78251-3312
Mailing address
10718 Potranco Rd
San Antonio, TX 78251-3312
Phone (210) 681-2301
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 173021 | TX | MD | Pharmacy Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1610323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610323200000",
"number": "1124617550",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10718 POTRANCO RD",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782513312",
"telephone_number": "210-681-2301",
"fax_number": "210-681-5736"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10718 POTRANCO RD",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782513312",
"telephone_number": "210-681-2301"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "MARY",
"middle_name": "ELIZABETH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-01-11",
"last_updated": "2021-01-11",
"certification_date": "2021-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": "TX",
"license": "173021",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.