Provider Demographics
NPI:1861715450
Name:DOVER, KEVIN TAYLOR
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:TAYLOR
Last Name:DOVER
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 1:3348 RIVER NARROWS RD
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7830
Mailing Address - Country:US
Mailing Address - Phone:614-771-5404
Mailing Address - Fax:614-771-5404
Practice Address - Street 1:5005 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1928
Practice Address - Country:US
Practice Address - Phone:614-451-0930
Practice Address - Fax:451-459-1675
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK03112196183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist