Provider Demographics
NPI:1033455399
Name:NAGENGAST, KEVIN MARK (PHARMD)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:MARK
Last Name:NAGENGAST
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:60 RANCHO RD STE 7
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-6000
Mailing Address - Country:US
Mailing Address - Phone:805-379-9200
Mailing Address - Fax:805-379-3900
Practice Address - Street 1:60 RANCHO RD STE 7
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-6000
Practice Address - Country:US
Practice Address - Phone:805-379-9200
Practice Address - Fax:805-379-3900
Is Sole Proprietor?:No
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 54794183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist