Provider Demographics
NPI:1427754027
Name:WINICKI, KEVIN NEAL (RPH)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:NEAL
Last Name:WINICKI
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 1:44 SKYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-2439
Mailing Address - Country:US
Mailing Address - Phone:860-884-4830
Mailing Address - Fax:860-537-4160
Practice Address - Street 1:119 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-1456
Practice Address - Country:US
Practice Address - Phone:860-537-0711
Practice Address - Fax:860-537-4160
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7827183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist