=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780907808
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES J KITTS RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2010
-----------------------------------------------------
Last Update Date | 03/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 428 BALLTOWN RD TARGET 1521
-----------------------------------------------------
City | SCHENECTADY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12304-2245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-346-8670
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 THISTLEDOWN CT
-----------------------------------------------------
City | LOUDONVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12211-1947
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-505-7597
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 025928-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------