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General NPI Number Information
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NPI Number | 1235236431
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Entity Type | Organization
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Legal Business Name | ROBERT KEVORKIAN
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 01/23/2017
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Provider Practice Location Address
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Address Line | 1418 HOPMEADOW ST
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City | SIMSBURY
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State | CT
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Zip | 06070-1410
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Country | US
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Telephone | 860-658-4489
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Fax | 860-651-7663
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Provider Business Mailing Address
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Address Line | 1418 HOPMEADOW ST
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City | SIMSBURY
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State | CT
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Zip | 06070-1410
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Country | US
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Telephone | 860-658-4489
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Fax | 860-651-7663
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT KEVORKIAN
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Credential | RPH PHD
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Telephone | 860-658-4489
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PCY0000856
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License Number State | CT
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