Provider Demographics
NPI:1598991804
Name:KIRBY, KEVIN LANCE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LANCE
Last Name:KIRBY
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 1:625 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE BUTLER
Mailing Address - State:FL
Mailing Address - Zip Code:32054-1352
Mailing Address - Country:US
Mailing Address - Phone:386-496-8099
Mailing Address - Fax:386-496-3796
Practice Address - Street 1:625 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE BUTLER
Practice Address - State:FL
Practice Address - Zip Code:32054-1352
Practice Address - Country:US
Practice Address - Phone:386-496-8099
Practice Address - Fax:386-496-3796
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32658183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS32658OtherSTATE LICENSE NUMBER