MEDICARE: KEVIN WINSTON RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861589715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN WINSTON RPH

Provider Business Mailing Address
First Line	:	213 FORESTWAY DR
Second Line	:
City	:	DEERFIELD
State	:	IL
Zip	:	60015-4809
Country	:	US
Telephone Number	:	847-226-0085
Fax Number	:	847-770-4454

Provider Business Practice Location Address
First Line	:	801 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-3009
Country	:	US
Telephone Number	:	773-525-0081
Fax Number	:	773-525-0095

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/08/2007

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