Provider Demographics
NPI:1598355877
Name:FRYE, KEVIN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:FRYE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 566
Mailing Address - Street 2:
Mailing Address - City:PRINCEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61559-0566
Mailing Address - Country:US
Mailing Address - Phone:309-385-4955
Mailing Address - Fax:309-385-1561
Practice Address - Street 1:206 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PRINCEVILLE
Practice Address - State:IL
Practice Address - Zip Code:61559-7516
Practice Address - Country:US
Practice Address - Phone:309-385-4955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051299201183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1750455127OtherNPI-PRINCEVILLE PHARMACY