Active NPI
Kyle Giles Rabideau, PHARMD
- Pharmacist
- Malone, NY
National Provider Identifier
1487080610
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 058275
- Practice address
- 3400 US-11
Malone, NY 12953 - Phone
- (518) 483-4110
- Fax
- (518) 483-2815
- NPI assigned
- Sep 19, 2013
- 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 | 058275 | NY | Primary |
Addresses
Primary practice location
3400 US-11
Malone, NY 12953
Mailing address
3400 US-11
Malone, NY 12953-1751
Phone (518) 483-4110
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 058275 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | 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.
-
- Pharmacy
- Malone, NY
- NPI 1063623841
-
- Pharmacy
- Longview, TX
- NPI 1629956545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1379548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714435200000",
"number": "1487080610",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3400 US-11",
"city": "MALONE",
"state": "NY",
"postal_code": "129531751",
"telephone_number": "518-483-4110",
"fax_number": "518-483-2815"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3400 US-11",
"city": "MALONE",
"state": "NY",
"postal_code": "12953",
"telephone_number": "518-483-4110",
"fax_number": "518-483-2815"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RABIDEAU",
"first_name": "KYLE",
"middle_name": "GILES",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-09-19",
"last_updated": "2024-04-30",
"certification_date": "2024-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "058275",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Malone, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.