Provider Demographics
NPI:1861714289
Name:KLEIN, MARC KEVIN (RPH)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:KEVIN
Last Name:KLEIN
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 1:1215 MAMARONECK AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-4807
Mailing Address - Country:US
Mailing Address - Phone:914-948-4818
Mailing Address - Fax:914-949-5633
Practice Address - Street 1:1215 MAMARONECK AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-4807
Practice Address - Country:US
Practice Address - Phone:914-948-4818
Practice Address - Fax:914-949-5633
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist