Provider Demographics
NPI:1255656310
Name:MCCANN, RICHARD KEVIN
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:KEVIN
Last Name:MCCANN
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 1:17 6TH ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12839-1515
Mailing Address - Country:US
Mailing Address - Phone:518-747-6690
Mailing Address - Fax:518-747-6667
Practice Address - Street 1:166 MAIN ST
Practice Address - Street 2:
Practice Address - City:HUDSON FALLS
Practice Address - State:NY
Practice Address - Zip Code:12839-1846
Practice Address - Country:US
Practice Address - Phone:518-747-4732
Practice Address - Fax:518-747-6667
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031434183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist