Provider Demographics
NPI:1588962195
Name:KEGLOVITS, KURT
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:
Last Name:KEGLOVITS
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 1:26966 CREST DR
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-6986
Mailing Address - Country:US
Mailing Address - Phone:302-628-0997
Mailing Address - Fax:302-875-2494
Practice Address - Street 1:1120 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:DE
Practice Address - Zip Code:19956-1418
Practice Address - Country:US
Practice Address - Phone:302-875-7844
Practice Address - Fax:302-875-2494
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-05
Last Update Date:2011-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0003335183500000X
PARP044270L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist