Provider Demographics
NPI:1669154548
Name:KENNARD, BENJAMIN CORUM (PHARMD, MS)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:CORUM
Last Name:KENNARD
Suffix:
Gender:M
Credentials:PHARMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 GREENDALE RD UNIT 11105
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-8343
Mailing Address - Country:US
Mailing Address - Phone:865-257-3334
Mailing Address - Fax:
Practice Address - Street 1:2000 HARRODSBURG RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1703
Practice Address - Country:US
Practice Address - Phone:859-276-5493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY023697183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist