Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Kevin Gary Wallace, PHARMD

Individual provider Pharmacist · NPI 1144576919

Kevin Gary Wallace, PHARMD is a Pharmacist in Staten Island, New York. Practices as a sole proprietor. Licensed in New York.

Licensed in
NY
In the registry since
2012
What do these letters mean?
PHARMD — Doctor of Pharmacy
The professional degree required to practise as a pharmacist in the United States.

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Practice location Address checks out

94 Ladd Ave
Staten Island, NY 10312-1515
Phone: (917) 270-4362
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pharmacist (primary) Taxonomy 183500000X · Licence 057064 (NY)

Record details

NPI number1144576919
Entity typeIndividual (Type 1)
GenderMale
Credentials PHARMD
Sole proprietorYes
NPI enumeratedJuly 31, 2012
Last updated in NPPESJuly 31, 2012

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