Provider Demographics
NPI:1861776684
Name:MACH, KEVIN GARY (PHARMD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:GARY
Last Name:MACH
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 1:509 EAST 78TH ST
Mailing Address - Street 2:#2C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10076
Mailing Address - Country:US
Mailing Address - Phone:203-444-6721
Mailing Address - Fax:
Practice Address - Street 1:509 E 78TH ST
Practice Address - Street 2:#2C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1154
Practice Address - Country:US
Practice Address - Phone:203-444-6721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055683183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist