Provider Demographics
NPI:1962770933
Name:KILGUS, JAMES (RPH)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:KILGUS
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 1:25 ROBERT JACKSON WAY
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-2650
Mailing Address - Country:US
Mailing Address - Phone:860-793-2800
Mailing Address - Fax:
Practice Address - Street 1:25 ROBERT JACKSON WAY
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-2650
Practice Address - Country:US
Practice Address - Phone:860-793-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT 00112591835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric