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NPI Code Detail

MEDICARE: DR. KEVIN HOWARD RIDGEWAY PHARM.D.

MEDICARE: DR. KEVIN HOWARD RIDGEWAY PHARM.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist20047955NY

General Provider Information

NPI Number : 1023292448
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEVIN HOWARD RIDGEWAY PHARM.D.
Provider Business Mailing Address
First Line : 6438 BASILE ROWE
Second Line :
City : EAST SYRACUSE
State : NY
Zip : 13057-3900
Country : US
Telephone Number : 315-434-9755
Fax Number :
Provider Business Practice Location Address
First Line : 6438 BASILE ROWE
Second Line :
City : EAST SYRACUSE
State : NY
Zip : 13057-3900
Country : US
Telephone Number : 315-434-9755
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2007
Last Update Date : 12/20/2007

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