Provider Demographics
NPI:1043542756
Name:VILLANI, KENNETH (RPH)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:
Last Name:VILLANI
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 1:11 FIELDSTONE LN
Mailing Address - Street 2:
Mailing Address - City:OYSTER BAY
Mailing Address - State:NY
Mailing Address - Zip Code:11771-3122
Mailing Address - Country:US
Mailing Address - Phone:516-624-7688
Mailing Address - Fax:
Practice Address - Street 1:8223 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-1810
Practice Address - Country:US
Practice Address - Phone:516-367-2266
Practice Address - Fax:516-367-4443
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029406183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist