Provider Demographics
NPI:1275342545
Name:ROBERT KEVORKIAN
Entity type:Organization
Organization Name:ROBERT KEVORKIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:KEVORKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:860-658-4489
Mailing Address - Street 1:1418 HOPMEADOW ST
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-1493
Mailing Address - Country:US
Mailing Address - Phone:860-658-4489
Mailing Address - Fax:860-651-7663
Practice Address - Street 1:1418 HOPMEADOW ST
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-1493
Practice Address - Country:US
Practice Address - Phone:860-658-4489
Practice Address - Fax:860-651-7663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy