Provider Demographics
NPI:1730287863
Name:KEVORKIAN, ROBERT C (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:KEVORKIAN
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 1:484 FIRETOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070
Mailing Address - Country:US
Mailing Address - Phone:860-651-1709
Mailing Address - Fax:860-651-7663
Practice Address - Street 1:484 FIRETOWN RD
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-1143
Practice Address - Country:US
Practice Address - Phone:860-651-1709
Practice Address - Fax:860-651-7663
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5380183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist