Provider Demographics
NPI:1700896362
Name:KENNEL, SANDRA M (RPH PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:M
Last Name:KENNEL
Suffix:
Gender:F
Credentials:RPH PHARMD
Other - Prefix:DR
Other - First Name:SANDRA
Other - Middle Name:A
Other - Last Name:MROCHEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH,PHARMD
Mailing Address - Street 1:4437 S TRACE BLVD
Mailing Address - Street 2:
Mailing Address - City:OLD HICKORY
Mailing Address - State:TN
Mailing Address - Zip Code:37138-4206
Mailing Address - Country:US
Mailing Address - Phone:615-847-4213
Mailing Address - Fax:
Practice Address - Street 1:1310 24TH AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2637
Practice Address - Country:US
Practice Address - Phone:615-327-4751
Practice Address - Fax:615-321-6310
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN76911835N1003X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
No183500000XPharmacy Service ProvidersPharmacist