Provider Demographics
NPI:1396158119
Name:BUI, KEVIN SHANE (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:SHANE
Last Name:BUI
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:ALTON BAY
Mailing Address - State:NH
Mailing Address - Zip Code:03810-0092
Mailing Address - Country:US
Mailing Address - Phone:207-576-8824
Mailing Address - Fax:
Practice Address - Street 1:190 WAKEFIELD ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-1304
Practice Address - Country:US
Practice Address - Phone:603-332-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3756183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist