Healthcare Provider Details

I. General information

NPI: 1003749607
Provider Name (Legal Business Name): KYLE ROBERT DEAKIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2145 BELLMORE AVE
BELLMORE NY
11710-5607
US

IV. Provider business mailing address

1057 BARRIE AVE
WANTAGH NY
11793-1746
US

V. Phone/Fax

Practice location:
  • Phone: 516-221-7694
  • Fax:
Mailing address:
  • Phone: 917-309-2164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number073985
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: