Provider Demographics
NPI:1740563360
Name:VOLKER, KENT C (RPH, MS)
Entity Type:Individual
Prefix:MR
First Name:KENT
Middle Name:C
Last Name:VOLKER
Suffix:
Gender:M
Credentials:RPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 S MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-4522
Mailing Address - Country:US
Mailing Address - Phone:217-744-1880
Mailing Address - Fax:217-744-1432
Practice Address - Street 1:2020 S MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-4522
Practice Address - Country:US
Practice Address - Phone:217-744-1880
Practice Address - Fax:217-744-1432
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.037341183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist