Provider Demographics
NPI:1538413950
Name:KEVORKIAN, DAVID S (RPH)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:S
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 1:1910 S REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1438
Mailing Address - Country:US
Mailing Address - Phone:419-867-3529
Mailing Address - Fax:419-867-3885
Practice Address - Street 1:1910 S REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-1438
Practice Address - Country:US
Practice Address - Phone:419-867-3529
Practice Address - Fax:419-867-3885
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-15393183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist