Provider Demographics
NPI:1821204744
Name:MCCABE, KEVIN M (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:M
Last Name:MCCABE
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 1:627 CLAPP HILL RD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540-6706
Mailing Address - Country:US
Mailing Address - Phone:845-223-8431
Mailing Address - Fax:
Practice Address - Street 1:623 MCLEAN AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-4734
Practice Address - Country:US
Practice Address - Phone:914-965-6100
Practice Address - Fax:914-965-6948
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048615183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist