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General NPI Number Information
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NPI Number | 1679177349
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Entity Type | Individual
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Provider Name | KEVIN GARY COYNE
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Gender | Male
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Dates
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Enumeration Date | 11/24/2020
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Last Update Date | 11/24/2020
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Provider Practice Location Address
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Address Line | 1282 SPRINGFIELD ST
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City | FEEDING HILLS
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State | MA
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Zip | 01030-2119
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Country | US
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Telephone | 413-789-2226
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Fax | 413-786-2422
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Provider Business Mailing Address
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Address Line | 1282 SPRINGFIELD ST
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City | FEEDING HILLS
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State | MA
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Zip | 01030-2119
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Country | US
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Telephone | 413-789-2226
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Fax | 413-786-2422
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH24045
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License Number State | MA
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