Provider Demographics
NPI:1205004256
Name:CAGGIANO, KENNETH ANTHONY (RPH)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:ANTHONY
Last Name:CAGGIANO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6070 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2806
Mailing Address - Country:US
Mailing Address - Phone:631-499-3900
Mailing Address - Fax:
Practice Address - Street 1:6070 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2806
Practice Address - Country:US
Practice Address - Phone:631-499-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029101183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist