MEDICARE: DR. SANDRA M. KENNEL RPH PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835N1003X	Nutrition Support Pharmacist	7691	TN
2	183500000X	Pharmacist	7691	TN

General Provider Information

NPI Number	:	1700896362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA M. KENNEL RPH PHARMD

Provider Business Mailing Address
First Line	:	4437 S TRACE BLVD
Second Line	:
City	:	OLD HICKORY
State	:	TN
Zip	:	37138-4206
Country	:	US
Telephone Number	:	615-847-4213
Fax Number	:

Provider Business Practice Location Address
First Line	:	1310 24TH AVE S
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37212-2637
Country	:	US
Telephone Number	:	615-327-4751
Fax Number	:	615-321-6310

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	12/07/2017

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