Provider Demographics
NPI:1184322240
Name:KING, KEVIN BRYAN (PHARMD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:BRYAN
Last Name:KING
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 1:12000 PRINCETON DR
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-7654
Mailing Address - Country:US
Mailing Address - Phone:224-569-6518
Mailing Address - Fax:
Practice Address - Street 1:12000 PRINCETON DR
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-7654
Practice Address - Country:US
Practice Address - Phone:224-569-6518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051305377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist