Provider Demographics
NPI:1255763405
Name:SILLS, KENNETH ROSS (RPH)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:ROSS
Last Name:SILLS
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 1:20 MAIN ST # 566
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06068-1800
Mailing Address - Country:US
Mailing Address - Phone:860-435-9388
Mailing Address - Fax:860-435-0258
Practice Address - Street 1:20 MAIN ST # 566
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:CT
Practice Address - Zip Code:06068-1800
Practice Address - Country:US
Practice Address - Phone:860-435-9388
Practice Address - Fax:860-435-0258
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5249183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist