Provider Demographics
NPI:1861785164
Name:KENNEDY-BRYANT, SHIRLEY KAYE (PHARMD)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:KAYE
Last Name:KENNEDY-BRYANT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1436 ELMFORK RD
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-9675
Mailing Address - Country:US
Mailing Address - Phone:859-967-9226
Mailing Address - Fax:
Practice Address - Street 1:1401 KEENE RD
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-8922
Practice Address - Country:US
Practice Address - Phone:859-881-3682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY015158183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist