Provider Demographics
NPI:1063587715
Name:KANIA, KEVIN FRANCIS
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:FRANCIS
Last Name:KANIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 ABBOTT RD
Mailing Address - Street 2:
Mailing Address - City:LACKAWANNA
Mailing Address - State:NY
Mailing Address - Zip Code:14218-2001
Mailing Address - Country:US
Mailing Address - Phone:716-823-3131
Mailing Address - Fax:716-823-0405
Practice Address - Street 1:1385 ABBOTT RD
Practice Address - Street 2:
Practice Address - City:LACKAWANNA
Practice Address - State:NY
Practice Address - Zip Code:14218-2001
Practice Address - Country:US
Practice Address - Phone:716-823-3131
Practice Address - Fax:716-823-0405
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADIPLOMA WAS ISSUED183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician