Provider Demographics
NPI:1295835957
Name:KIRBY, KEVIN TODD (DPH)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:TODD
Last Name:KIRBY
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5104 S LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-6542
Mailing Address - Country:US
Mailing Address - Phone:918-747-8841
Mailing Address - Fax:918-747-6639
Practice Address - Street 1:5104 S LEWIS AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6542
Practice Address - Country:US
Practice Address - Phone:918-747-8841
Practice Address - Fax:918-747-6639
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11259183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist