Provider Demographics
NPI:1811219389
Name:KIST, WILLIAM A JR (R PH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:A
Last Name:KIST
Suffix:JR
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:55 W AMES CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-2407
Mailing Address - Country:US
Mailing Address - Phone:516-938-8080
Mailing Address - Fax:877-374-8036
Practice Address - Street 1:55 W AMES CT
Practice Address - Street 2:SUITE 200
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-2407
Practice Address - Country:US
Practice Address - Phone:516-938-8080
Practice Address - Fax:877-374-8036
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY028268183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist