Provider Demographics
NPI:1346737640
Name:MACHI, KEVIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:MACHI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 AUTUMN WAY
Mailing Address - Street 2:
Mailing Address - City:LEDYARD
Mailing Address - State:CT
Mailing Address - Zip Code:06339-1658
Mailing Address - Country:US
Mailing Address - Phone:860-917-5548
Mailing Address - Fax:
Practice Address - Street 1:3 N 2ND AVE
Practice Address - Street 2:
Practice Address - City:TAFTVILLE
Practice Address - State:CT
Practice Address - Zip Code:06380-1407
Practice Address - Country:US
Practice Address - Phone:860-383-2013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0014175183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist