Provider Demographics
NPI:1831513381
Name:ROLLER, KENDRA NICOLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:NICOLE
Last Name:ROLLER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 N MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:TN
Mailing Address - Zip Code:37650-1255
Mailing Address - Country:US
Mailing Address - Phone:423-743-7105
Mailing Address - Fax:
Practice Address - Street 1:109 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:TN
Practice Address - Zip Code:37650-1255
Practice Address - Country:US
Practice Address - Phone:423-743-7105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35838183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist