Provider Demographics
NPI:1508919515
Name:KRILEY, KEVIN L (RPH)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:L
Last Name:KRILEY
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 1:125 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SMITH CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:66967-2605
Mailing Address - Country:US
Mailing Address - Phone:785-282-6843
Mailing Address - Fax:785-282-6844
Practice Address - Street 1:125 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SMITH CENTER
Practice Address - State:KS
Practice Address - Zip Code:66967-2605
Practice Address - Country:US
Practice Address - Phone:785-282-6843
Practice Address - Fax:785-282-6844
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11052183500000X
TX29239183500000X
KS208877333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1314180001Medicare NSC