Healthcare Provider Details

I. General information

NPI: 1356973382
Provider Name (Legal Business Name): KEITH MATTHEW KALVAITIS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 02/07/2020
Certification Date: 02/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

35 ROBERT RD
PENFIELD NY
14526-9718
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-2100
  • Fax:
Mailing address:
  • Phone: 574-309-2536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number051942
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: