Provider Demographics
NPI:1023292448
Name:RIDGEWAY, KEVIN HOWARD (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:HOWARD
Last Name:RIDGEWAY
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 1:6438 BASILE ROWE
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-3900
Mailing Address - Country:US
Mailing Address - Phone:315-434-9755
Mailing Address - Fax:
Practice Address - Street 1:6438 BASILE ROWE
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-3900
Practice Address - Country:US
Practice Address - Phone:315-434-9755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20047955183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist