Active NPI
Brian David Kennedy, R.PH.
- Pharmacist
- Lake City, MN
National Provider Identifier
1376695247
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 115760-6
- Practice address
- 223 S Lakeshore Dr
Lake City, MN 55041-1642 - Phone
- (651) 345-3411
- Fax
- (651) 345-4848
- NPI assigned
- Jan 18, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 115760-6 | MN | Primary |
Addresses
Primary practice location
223 S Lakeshore Dr
Lake City, MN 55041-1642
Mailing address
30151 715TH St
Lake City, MN 55041-5002
Phone (651) 345-5010
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
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 115760-6 | MN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376695247",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30151 715TH ST",
"city": "LAKE CITY",
"state": "MN",
"postal_code": "550415002",
"telephone_number": "651-345-5010",
"fax_number": "651-345-1158"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "223 S LAKESHORE DR",
"city": "LAKE CITY",
"state": "MN",
"postal_code": "550411642",
"telephone_number": "651-345-3411",
"fax_number": "651-345-4848"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "BRIAN",
"middle_name": "DAVID",
"credential": "R.PH.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "115760-6",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake City, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.