Provider Demographics
NPI:1952905416
Name:BEATTY, KEVIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:BEATTY
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 1:1827 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2505
Mailing Address - Country:US
Mailing Address - Phone:914-737-3728
Mailing Address - Fax:
Practice Address - Street 1:1827 MAIN ST
Practice Address - Street 2:
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-2505
Practice Address - Country:US
Practice Address - Phone:914-737-3728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062026183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty