Basic Information
| Provider Information | |||||||||
| NPI: | 1891027652 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KENNADAY | ||||||||
| FirstName: | SELENA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARM D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 FUN CENTER DRIVE | ||||||||
| Address2: | WALMART PHARMACY | ||||||||
| City: | SURF CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9108036003 | ||||||||
| FaxNumber: | 9108036004 | ||||||||
| Practice Location | |||||||||
| Address1: | 420 FUN CENTER DRIVE | ||||||||
| Address2: | WALMART PHARMACY | ||||||||
| City: | SURF CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9108036003 | ||||||||
| FaxNumber: | 9108036004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2010 | ||||||||
| LastUpdateDate: | 11/24/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 053530 | NY | Y | Pharmacy Service Providers | Pharmacist | 183500000X | 21304 | NC | N | Pharmacy Service Providers | Pharmacist |
No ID Information.