Provider Demographics
NPI:1679341572
Name:CORTES, KENNETH JOEL (PHARMD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:JOEL
Last Name:CORTES
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 1:2350 8TH AVE S APT 210
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-2298
Mailing Address - Country:US
Mailing Address - Phone:787-942-5590
Mailing Address - Fax:
Practice Address - Street 1:426 21ST AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2424
Practice Address - Country:US
Practice Address - Phone:787-942-5590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48313183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist