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NPI Code Detail

MEDICARE: MR. KEVIN D. REILLY

MEDICARE: MR. KEVIN D. REILLY
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
1183500000XPharmacist33647NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538342373
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KEVIN D. REILLY
Provider Business Mailing Address
First Line : 93 BROADMOOR TRL
Second Line : PO BOX 231
City : FAIRPORT
State : NY
Zip : 14450-9386
Country : US
Telephone Number : 585-388-0931
Fax Number : 585-425-2327
Provider Business Practice Location Address
First Line : 1792 N GOODMAN ST
Second Line :
City : ROCHESTER
State : NY
Zip : 14609-1036
Country : US
Telephone Number : 585-467-4422
Fax Number : 585-266-3057
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2007
Last Update Date : 12/16/2007

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