Provider Demographics
NPI:1326270091
Name:NEVIN, DAVID (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:NEVIN
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 1:2949 STATE ROUTE 370
Mailing Address - Street 2:
Mailing Address - City:CATO
Mailing Address - State:NY
Mailing Address - Zip Code:13033-9778
Mailing Address - Country:US
Mailing Address - Phone:315-626-3161
Mailing Address - Fax:315-626-9919
Practice Address - Street 1:2949 STATE ROUTE 370
Practice Address - Street 2:
Practice Address - City:CATO
Practice Address - State:NY
Practice Address - Zip Code:13033
Practice Address - Country:US
Practice Address - Phone:315-626-3161
Practice Address - Fax:315-626-9919
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-14
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049221183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
9107084OtherBOARD OF PHARMACY SPECIALTIES
NY049221OtherNEW YORK STATE PHARMACIST LICENSE