Provider Demographics
NPI:1154549970
Name:LEVESQUE, KEVIN
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:LEVESQUE
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 1:2501 CARRIAGE CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-8827
Mailing Address - Country:US
Mailing Address - Phone:704-841-1865
Mailing Address - Fax:714-841-1394
Practice Address - Street 1:1830 GALLERIA BLVD.
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270
Practice Address - Country:US
Practice Address - Phone:704-841-1865
Practice Address - Fax:714-841-1394
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4851183500000X
NC19322183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC19322OtherNC BOARD OF PHARMACY
MEPR4851OtherPHARMACIST LICENSE