Provider Demographics
NPI:1679177349
Name:COYNE, KEVIN GARY
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:GARY
Last Name:COYNE
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 1:1282 SPRINGFIELD ST
Mailing Address - Street 2:
Mailing Address - City:FEEDING HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:01030-2119
Mailing Address - Country:US
Mailing Address - Phone:413-789-2226
Mailing Address - Fax:413-786-2422
Practice Address - Street 1:1282 SPRINGFIELD ST
Practice Address - Street 2:
Practice Address - City:FEEDING HILLS
Practice Address - State:MA
Practice Address - Zip Code:01030-2119
Practice Address - Country:US
Practice Address - Phone:413-789-2226
Practice Address - Fax:413-786-2422
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH240453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy