Individual
MR. KEVIN JOHN WAITE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
140 KEYLAND CT UNIT 27, BOHEMIA, NY 11716-2655
(631) 750-9088
Mailing address
140 KEYLAND CT UNIT 27, BOHEMIA, NY 11716-2655
(631) 750-9088
Taxonomy
Speciality
Code
Description
License number
State
1835N1003X
Nutrition Support Pharmacist
Primary
061399
NY
Other
Enumeration date
02/17/2016
Last updated
02/17/2016
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