| Doctor Name: | MR. KEVIN JOHN WAITE |
| NPI Number: | 1346609476 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHARMD |
| License Number: | 061399 |
| Business Practice Address: | 140 Keyland Ct Unit 27 Bohemia, NY - 117162655 |
| Business Phone Number: | 6317509088 |
| Business Fax Number: | |
| Mailing Address: | 140 Keyland Ct Unit 27, BOHEMIA |
| State: | NY |
| Postal Code: | 117162655 |
| Phone Number: | 6317509088 |
| Fax Number: | |
| NPI Enumeration Date: | 02/17/2016 |
| NPI Last Update Date: | 02/17/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1835N1003X |
| License Number: | 061399 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Pharmacy Service Providers |
| Taxonomy Classification: | Pharmacist |
| Taxonomy Specialization: | Nutrition Support |
| Taxonomy Definition: | A licensed pharmacist who has demonstrated specialized knowledge and skill in maintenance and/or restoration of optimal nutritional status, designing and modifying treatment according to patient needs. |