Active NPI
John Lowry Kennedy, PHARMACIST
- Pharmacist
- Statesville, NC
National Provider Identifier
1962736835
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 4799
- Practice address
- 1716 E Broad St
Statesville, NC 28625-4306 - Phone
- (704) 872-8131
- NPI assigned
- Sep 25, 2009
- 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 | 4799 | NC | Primary |
Addresses
Primary practice location
1716 E Broad St
Statesville, NC 28625-4306
Mailing address
620 Berkshire Dr
Statesville, NC 28677-6020
Phone (704) 873-6297
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0496603 | Medicaid | NC |
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 |
|---|---|---|---|
| 4799 | NC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253836800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1253836800000",
"number": "1962736835",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "620 BERKSHIRE DR",
"city": "STATESVILLE",
"state": "NC",
"postal_code": "286776020",
"telephone_number": "704-873-6297"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1716 E BROAD ST",
"city": "STATESVILLE",
"state": "NC",
"postal_code": "286254306",
"telephone_number": "704-872-8131"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "JOHN",
"middle_name": "LOWRY",
"name_prefix": "Mr.",
"credential": "PHARMACIST",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-09-25",
"last_updated": "2009-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NC",
"license": "4799",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0496603",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Statesville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.