Active NPI
Kennedy Ryan
- Pharmacist
- Cloverdale, IN
National Provider Identifier
1609491554
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 26027702A
- Practice address
- 900 N Main St
Cloverdale, IN 46120-8506 - Phone
- (765) 795-4100
- NPI assigned
- Jun 16, 2020
- Last updated
- Mar 2, 2022
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 26027702A | IN | Primary |
Addresses
Primary practice location
900 N Main St
Cloverdale, IN 46120-8506
Mailing address
PO Box 357
Cloverdale, IN 46120-0357
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 |
|---|---|---|---|
| 26027702A | IN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cloverdale Drugs, Inc | Pharmacist | Current | Accepting new patients |
Locations
900 N Main St
Cloverdale, IN 46120
Phone (765) 795-4100
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1592265600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1646179200000",
"number": "1609491554",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 357",
"city": "CLOVERDALE",
"state": "IN",
"postal_code": "461200357"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 N MAIN ST",
"city": "CLOVERDALE",
"state": "IN",
"postal_code": "461208506",
"telephone_number": "765-795-4100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RYAN",
"first_name": "KENNEDY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-06-16",
"last_updated": "2022-03-02",
"certification_date": "2022-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IN",
"license": "26027702A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cloverdale, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.