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General NPI Number Information
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NPI Number | 1053074955
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Entity Type | Individual
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Provider Name | DAVID KINGSLEY
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Gender | Male
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Dates
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Enumeration Date | 10/18/2021
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Last Update Date | 10/18/2021
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Provider Practice Location Address
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Address Line | 315 S MANNING BLVD
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City | ALBANY
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State | NY
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Zip | 12208-1789
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Country | US
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Telephone | 518-525-1550
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Fax |
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Provider Business Mailing Address
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Address Line | 345 QUAIL ST APT 6
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City | ALBANY
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State | NY
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Zip | 12208-3245
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Country | US
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Telephone | 602-425-8627
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 068240
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License Number State | NY
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