Provider Demographics
NPI:1770760811
Name:HOEY, KEVIN M (RPH)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:M
Last Name:HOEY
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 1:431 W COTTAGE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53527-9385
Mailing Address - Country:US
Mailing Address - Phone:608-839-3784
Mailing Address - Fax:608-839-3786
Practice Address - Street 1:431 W COTTAGE GROVE RD
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:WI
Practice Address - Zip Code:53527-9385
Practice Address - Country:US
Practice Address - Phone:608-839-3784
Practice Address - Fax:608-839-3786
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11164-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11164-040OtherWI RPH LICENSE