Active NPI
David A Kennedy, PHARMD
- Pharmacist
- Rexburg, ID
National Provider Identifier
1609277482
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- P6652
- Practice address
- 450 E Main St
Rexburg, ID 83440-2048 - Phone
- (208) 359-6487
- Fax
- (208) 359-6467
- NPI assigned
- Sep 11, 2014
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | P6652 | ID | Primary |
Addresses
Primary practice location
450 E Main St
Rexburg, ID 83440-2048
Mailing address
450 E Main St
Rexburg, ID 83440-2048
Phone (208) 359-6487
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P6652 | ID | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410393600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410393600000",
"number": "1609277482",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "450 E MAIN ST",
"city": "REXBURG",
"state": "ID",
"postal_code": "834402048",
"telephone_number": "208-359-6487",
"fax_number": "208-359-6467"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "450 E MAIN ST",
"city": "REXBURG",
"state": "ID",
"postal_code": "834402048",
"telephone_number": "208-359-6487",
"fax_number": "208-359-6467"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "DAVID",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-09-11",
"last_updated": "2014-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ID",
"license": "P6652",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rexburg, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.