Active NPI
Jack A. Kennedy, PHARMD
- Pharmacist
- Trevose, PA
National Provider Identifier
1679847958
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RP444283
- Practice address
- 4924 Somers Ave
Trevose, PA 19053-4863 - Phone
- (215) 322-2265
- NPI assigned
- Mar 3, 2012
- 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 | RP444283 | PA | Primary |
Addresses
Primary practice location
4924 Somers Ave
Trevose, PA 19053-4863
Mailing address
4924 Somers Ave
Trevose, PA 19053-4863
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RPI004193 | Other | PA | IMMUNIZER LICENSE |
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 |
|---|---|---|---|
| RP444283 | PA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1330732800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1330732800000",
"number": "1679847958",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4924 SOMERS AVE",
"city": "TREVOSE",
"state": "PA",
"postal_code": "190534863"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4924 SOMERS AVE",
"city": "TREVOSE",
"state": "PA",
"postal_code": "190534863",
"telephone_number": "215-322-2265"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "JACK",
"middle_name": "A.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-03-03",
"last_updated": "2012-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "PA",
"license": "RP444283",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IMMUNIZER LICENSE",
"identifier": "RPI004193",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Trevose, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.