Healthcare Provider Details

I. General information

NPI: 1891973558
Provider Name (Legal Business Name): KEVIN MICHAEL MOCERINE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FAITH PLAZA RT. 9W
RAVENA NY
12143
US

IV. Provider business mailing address

FAITH PLAZA RT. 9W
RAVENA NY
12143
US

V. Phone/Fax

Practice location:
  • Phone: 518-756-3157
  • Fax: 518-756-1681
Mailing address:
  • Phone: 518-756-3157
  • Fax: 518-756-1681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051052
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: