Provider Demographics
NPI:1326529579
Name:KANTOR, GABRIEL KEVIN (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:KEVIN
Last Name:KANTOR
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30048 JUDSON LN
Mailing Address - Street 2:
Mailing Address - City:DAGSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19939-3381
Mailing Address - Country:US
Mailing Address - Phone:443-617-2576
Mailing Address - Fax:
Practice Address - Street 1:36729 OLD MILL RD
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:DE
Practice Address - Zip Code:19967-6952
Practice Address - Country:US
Practice Address - Phone:302-539-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-26
Last Update Date:2018-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0005292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist