Provider Demographics
NPI:1538215256
Name:KIRK, JENNIFER SUZANNE (RPH)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUZANNE
Last Name:KIRK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 DAYTON BLVD
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:TN
Mailing Address - Zip Code:37415-2715
Mailing Address - Country:US
Mailing Address - Phone:423-877-9516
Mailing Address - Fax:423-877-9459
Practice Address - Street 1:3901 DAYTON BLVD
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:TN
Practice Address - Zip Code:37415-2715
Practice Address - Country:US
Practice Address - Phone:423-877-9516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8547183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist