Provider Demographics
NPI:1346580669
Name:MCBRIDE, KEVIN DALE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:DALE
Last Name:MCBRIDE
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 1:1200 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-3821
Mailing Address - Country:US
Mailing Address - Phone:618-242-2800
Mailing Address - Fax:618-242-6776
Practice Address - Street 1:1200 MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-3821
Practice Address - Country:US
Practice Address - Phone:618-242-2800
Practice Address - Fax:618-242-6776
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-23
Last Update Date:2013-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.291804183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist