Kristen Bleau
Individual provider Active NPI Pharmacist · Massena, NY
NPI 1972020717 · NPPES record last updated Aug 7, 2021
Key facts
- NPI
- 1972020717
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 063249 (NY)
- Practice address
- 300 Main St
Massena, NY 13662-1959 - Phone
- (315) 764-0559
- Fax
- (315) 764-9500
- NPI assigned
- Aug 23, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 063249 | NY | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| KPH Healthcare Services, Inc. | Past |
Accepting new patients | |
| KPH Healthcare Services, Inc. | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 063249 | NY | Yes |
Addresses
Primary practice location
300 Main St
Massena, NY 13662-1959
Mailing address
4 N Clarkson Ave
Massena, NY 13662-1765
Phone (315) 842-8837
Other practice location 1
908 State St
Ogdensburg, NY 13669-3348
Phone (315) 393-1714
Other practice location 2
48 Maple St
Potsdam, NY 13676-1124
Phone (315) 262-0529
Other names
- Kristen McKeel
Other providers in Massena, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 7, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.