Provider Demographics
NPI:1528658465
Name:DAVIS, KEVIN LLOYD (RPH)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:LLOYD
Last Name:DAVIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:IN
Mailing Address - Zip Code:47635-1123
Mailing Address - Country:US
Mailing Address - Phone:812-649-2227
Mailing Address - Fax:812-649-3253
Practice Address - Street 1:815 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:IN
Practice Address - Zip Code:47635-1123
Practice Address - Country:US
Practice Address - Phone:812-649-2227
Practice Address - Fax:812-649-3253
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014002A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist