Provider Demographics
NPI:1174909253
Name:KAVANAGH, REBECCA KENDRA (PHARMD, BCACP)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:KENDRA
Last Name:KAVANAGH
Suffix:
Gender:F
Credentials:PHARMD, BCACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 W 125TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4402
Mailing Address - Country:US
Mailing Address - Phone:122-851-1192
Mailing Address - Fax:
Practice Address - Street 1:230 W 125TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4402
Practice Address - Country:US
Practice Address - Phone:122-851-1192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060770183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist