Healthcare Provider Details

I. General information

NPI: 1811219389
Provider Name (Legal Business Name): WILLIAM A. KIST JR. R. PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 W AMES CT SUITE 200
PLAINVIEW NY
11803-2407
US

IV. Provider business mailing address

55 W AMES CT SUITE 200
PLAINVIEW NY
11803-2407
US

V. Phone/Fax

Practice location:
  • Phone: 516-938-8080
  • Fax: 877-374-8036
Mailing address:
  • Phone: 516-938-8080
  • Fax: 877-374-8036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number028268
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: