Provider Demographics
NPI:1376891325
Name:BLOCK, KEVIN T JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:T
Last Name:BLOCK
Suffix:JR
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 1:1842 WALNUT GLEN BLVD
Mailing Address - Street 2:
Mailing Address - City:ISLAND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60042-8832
Mailing Address - Country:US
Mailing Address - Phone:847-421-0494
Mailing Address - Fax:
Practice Address - Street 1:2323 CHARLES ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-1550
Practice Address - Country:US
Practice Address - Phone:815-399-1474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.295851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist