Provider Demographics
NPI:1851957427
Name:KINCAID, ALEXANDER EDWARD
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:EDWARD
Last Name:KINCAID
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 AVENUE OF THE CITIES
Mailing Address - Street 2:
Mailing Address - City:EAST MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61244-4114
Mailing Address - Country:US
Mailing Address - Phone:309-755-0325
Mailing Address - Fax:309-755-0514
Practice Address - Street 1:1301 AVENUE OF THE CITIES
Practice Address - Street 2:
Practice Address - City:EAST MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61244-4114
Practice Address - Country:US
Practice Address - Phone:309-755-0325
Practice Address - Fax:309-755-0514
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-19
Last Update Date:2019-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22810183500000X
IL051299748183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist