Provider Demographics
NPI:1154676724
Name:KINCADE, AMANDA MOORE (RPH)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MOORE
Last Name:KINCADE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 BATTLEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-2920
Mailing Address - Country:US
Mailing Address - Phone:615-337-0164
Mailing Address - Fax:
Practice Address - Street 1:871 SEVEN OAKS BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6481
Practice Address - Country:US
Practice Address - Phone:615-462-6148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9916183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist