Provider Demographics
NPI:1699065474
Name:SMITH, KENDRICK (PHARMD)
Entity type:Individual
Prefix:
First Name:KENDRICK
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SNEEDVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37869-3849
Mailing Address - Country:US
Mailing Address - Phone:423-733-2322
Mailing Address - Fax:423-733-2140
Practice Address - Street 1:140 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SNEEDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37869-3849
Practice Address - Country:US
Practice Address - Phone:423-733-2322
Practice Address - Fax:423-733-2140
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21873183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist