Provider Demographics
NPI:1316657521
Name:MARVIN, KEVIN CHARLES (RPH)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:CHARLES
Last Name:MARVIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 MAQUAM SHORE RD
Mailing Address - Street 2:
Mailing Address - City:SWANTON
Mailing Address - State:VT
Mailing Address - Zip Code:05488-9638
Mailing Address - Country:US
Mailing Address - Phone:802-233-5760
Mailing Address - Fax:
Practice Address - Street 1:214 MAQUAM SHORE RD
Practice Address - Street 2:
Practice Address - City:SWANTON
Practice Address - State:VT
Practice Address - Zip Code:05488-9638
Practice Address - Country:US
Practice Address - Phone:802-233-5760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9779-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist