Provider Demographics
NPI:1699465997
Name:CAUDILL, KENNEDY GAMBILL (PHARMD)
Entity type:Individual
Prefix:
First Name:KENNEDY
Middle Name:GAMBILL
Last Name:CAUDILL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KENNEDY
Other - Middle Name:LINN
Other - Last Name:GAMBILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1021 W OAKLAND AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2192
Mailing Address - Country:US
Mailing Address - Phone:423-302-6565
Mailing Address - Fax:
Practice Address - Street 1:1905 AMERICAN WAY
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-5882
Practice Address - Country:US
Practice Address - Phone:423-578-8451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN446691835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care