MEDICARE: DR. REBECCA KENDRA KAVANAGH PHARMD, BCACP

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
1	183500000X	Pharmacist	060770	NY

General Provider Information

NPI Number	:	1174909253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REBECCA KENDRA KAVANAGH PHARMD, BCACP

Provider Business Mailing Address
First Line	:	230 W 125TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-4402
Country	:	US
Telephone Number	:	122-851-1192
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 W 125TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-4402
Country	:	US
Telephone Number	:	122-851-1192
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2015
Last Update Date	:	07/21/2022

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