MEDICARE: DR. KEVIN PHELAN LANGONE PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	070466	NY

General Provider Information

NPI Number	:	1386326932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN PHELAN LANGONE PHARMD

Provider Business Mailing Address
First Line	:	2480 US ROUTE 9W STE 3
Second Line	:
City	:	RAVENA
State	:	NY
Zip	:	12143-2863
Country	:	US
Telephone Number	:	518-756-3157
Fax Number	:

Provider Business Practice Location Address
First Line	:	2480 US ROUTE 9W STE 3
Second Line	:
City	:	RAVENA
State	:	NY
Zip	:	12143-2863
Country	:	US
Telephone Number	:	518-756-3157
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2023
Last Update Date	:	08/03/2023

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