Provider Demographics
NPI:1114961364
Name:DEVANEY, KIM PATRICK (RPH)
Entity Type:Individual
Prefix:MR
First Name:KIM
Middle Name:PATRICK
Last Name:DEVANEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 LUKE ST
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712-1427
Mailing Address - Country:US
Mailing Address - Phone:203-758-4938
Mailing Address - Fax:
Practice Address - Street 1:6 LUKE ST
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:CT
Practice Address - Zip Code:06712-1427
Practice Address - Country:US
Practice Address - Phone:203-758-4938
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist