Provider Demographics
NPI:1699404715
Name:PICOU, KEVIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:PICOU
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 1:126 KENT RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-3316
Mailing Address - Country:US
Mailing Address - Phone:917-391-4245
Mailing Address - Fax:
Practice Address - Street 1:101 CLARK ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-2743
Practice Address - Country:US
Practice Address - Phone:718-834-9003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068159183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYFH49364BMedicaid