Provider Demographics
NPI:1376701540
Name:KENNEDY, KIM HENLEY (RPH)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:HENLEY
Last Name:KENNEDY
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 1:1820 ROANE STATE HWY
Mailing Address - Street 2:
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-8307
Mailing Address - Country:US
Mailing Address - Phone:865-717-9496
Mailing Address - Fax:865-717-9288
Practice Address - Street 1:1820 ROANE STATE HWY
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-8307
Practice Address - Country:US
Practice Address - Phone:865-717-9496
Practice Address - Fax:865-717-9288
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-24
Last Update Date:2008-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4671183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist