Provider Demographics
NPI:1962501478
Name:KAIN, BRAD E (RPH)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:E
Last Name:KAIN
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 1:815 W HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:ELDRIDGE
Mailing Address - State:IA
Mailing Address - Zip Code:52748-1519
Mailing Address - Country:US
Mailing Address - Phone:563-285-5816
Mailing Address - Fax:
Practice Address - Street 1:3513 VINE CT
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-5823
Practice Address - Country:US
Practice Address - Phone:563-386-3220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18459183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist