Healthcare Provider Details

I. General information

NPI: 1063871721
Provider Name (Legal Business Name): JENNIFER LEE KIDWELL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2016
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7685 MALL RD
FLORENCE KY
41042-1403
US

IV. Provider business mailing address

7685 MALL RD
FLORENCE KY
41042-1403
US

V. Phone/Fax

Practice location:
  • Phone: 859-795-5820
  • Fax: 859-795-5821
Mailing address:
  • Phone: 859-795-5820
  • Fax: 859-795-5821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number013831
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: