=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871662312
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KEVIN & MILTON PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 378 LAFAYETTE AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11238-1311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-623-8930
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 378 LAFAYETTE AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11238-1311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-623-8930
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY
-----------------------------------------------------
Name | MRS. MARGARET THOMAS MATHAI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 516-739-7505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 028075
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------