Active NPI
Sean Alexander Kammerdener, RPH
- Pharmacist
- West Babylon, NY
National Provider Identifier
1245407121
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 047703
- Practice address
- 365 Route 109
West Babylon, NY 11704-6213 - Phone
- (631) 587-9455
- NPI assigned
- May 10, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 047703 | NY | Primary |
Addresses
Primary practice location
365 Route 109
West Babylon, NY 11704-6213
Mailing address
226 Cypress St
Massapequa Park, NY 11762-1748
Phone (631) 765-3894
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02101619 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 047703 | NY | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stop and Shop Supermarket Co LLC | Past | Accepting new patients | |
| The Stop & Shop Supermarket Company LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- West Babylon, NY
- NPI 1639103591
-
- Community/Retail Pharmacy
- Kinnelon, NJ
- NPI 1932570363
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225756800000",
"number": "1245407121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "226 CYPRESS ST",
"city": "MASSAPEQUA PARK",
"state": "NY",
"postal_code": "117621748",
"telephone_number": "631-765-3894"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "365 ROUTE 109",
"city": "WEST BABYLON",
"state": "NY",
"postal_code": "117046213",
"telephone_number": "631-587-9455"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KAMMERDENER",
"first_name": "SEAN",
"middle_name": "ALEXANDER",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-05-10",
"last_updated": "2008-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "047703",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02101619",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Babylon, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.