Stephen Richard Kettle, PHARMD
Individual provider Active NPI Pharmacist · Longboat Key, FL
NPI 1992308472 · NPPES record last updated Nov 18, 2020
Key facts
- NPI
- 1992308472
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PS61031 (FL)
- Practice address
- 505 Bay Isles Pkwy
Longboat Key, FL 34228-3133 - Phone
- (941) 383-2475
- NPI assigned
- Nov 18, 2020
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS61031 | FL | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS61031 | FL | Yes |
Addresses
Primary practice location
505 Bay Isles Pkwy
Longboat Key, FL 34228-3133
Mailing address
505 Bay Isles Pkwy
Longboat Key, FL 34228-3133
Phone (941) 383-2475
Other providers in Longboat Key, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 18, 2020. 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.