Provider Demographics
NPI:1851740328
Name:GUALBANCE, KEVIN (RPH)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:GUALBANCE
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 1:216 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-6333
Mailing Address - Country:US
Mailing Address - Phone:516-485-8774
Mailing Address - Fax:
Practice Address - Street 1:216 HENRY ST
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-6333
Practice Address - Country:US
Practice Address - Phone:516-485-8774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061064183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist