Provider Demographics
NPI:1720683634
Name:KOVAL, MARK ANDREW (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ANDREW
Last Name:KOVAL
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 1:75 N MIDDLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-2659
Mailing Address - Country:US
Mailing Address - Phone:845-735-8101
Mailing Address - Fax:
Practice Address - Street 1:75 N MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-2659
Practice Address - Country:US
Practice Address - Phone:845-735-8101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059166183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist