MEDICARE: JENNIFER LEE KIDWELL 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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	013831	KY

General Provider Information

NPI Number	:	1063871721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LEE KIDWELL PHARMD

Provider Business Mailing Address
First Line	:	7685 MALL RD
Second Line	:
City	:	FLORENCE
State	:	KY
Zip	:	41042-1403
Country	:	US
Telephone Number	:	859-795-5820
Fax Number	:	859-795-5821

Provider Business Practice Location Address
First Line	:	7685 MALL RD
Second Line	:
City	:	FLORENCE
State	:	KY
Zip	:	41042-1403
Country	:	US
Telephone Number	:	859-795-5820
Fax Number	:	859-795-5821

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

Provider Enumeration Date	:	02/23/2016
Last Update Date	:	05/29/2026

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