Provider Demographics
NPI:1871220087
Name:BROCK, KODI HUNNER (PHARMD)
Entity type:Individual
Prefix:
First Name:KODI
Middle Name:HUNNER
Last Name:BROCK
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 1:1 VIEWPOINT DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:KY
Mailing Address - Zip Code:41001-1086
Mailing Address - Country:US
Mailing Address - Phone:859-635-1420
Mailing Address - Fax:
Practice Address - Street 1:1 VIEWPOINT DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:KY
Practice Address - Zip Code:41001-1086
Practice Address - Country:US
Practice Address - Phone:859-635-1420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-07
Last Update Date:2022-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY022994183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist