Provider Demographics
NPI:1548678774
Name:HENRY, KENDALL (PHARMD)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:HENRY
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 1:1241 ROBINSON RD
Mailing Address - Street 2:
Mailing Address - City:OLD HICKORY
Mailing Address - State:TN
Mailing Address - Zip Code:37138-3345
Mailing Address - Country:US
Mailing Address - Phone:615-847-3109
Mailing Address - Fax:
Practice Address - Street 1:1241 ROBINSON RD
Practice Address - Street 2:
Practice Address - City:OLD HICKORY
Practice Address - State:TN
Practice Address - Zip Code:37138-3345
Practice Address - Country:US
Practice Address - Phone:615-847-3109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000036855183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist