MEDICARE: KINGSLEY BRISSETT

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	049285	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225201098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KINGSLEY BRISSETT

Provider Business Mailing Address
First Line	:	1516 WESTCHESTER AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10472-2907
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1516 WESTCHESTER AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10472-2907
Country	:	US
Telephone Number	:	718-861-2359
Fax Number	:

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

Provider Enumeration Date	:	04/11/2008
Last Update Date	:	04/11/2008

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Directions to “ KINGSLEY BRISSETT ” Practice Location

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