Provider Demographics
NPI:1083210751
Name:LITTLE, KEVIN FRANCIS
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:FRANCIS
Last Name:LITTLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 TOWNSHIP LINE RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLINVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08322-2840
Mailing Address - Country:US
Mailing Address - Phone:856-889-6611
Mailing Address - Fax:856-582-3962
Practice Address - Street 1:382 EGG HARBOR RD
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-1857
Practice Address - Country:US
Practice Address - Phone:856-582-3961
Practice Address - Fax:856-582-3962
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01615900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist