Provider Demographics
NPI:1861589715
Name:WINSTON, KEVIN (RPH)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:WINSTON
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 1:213 FORESTWAY DR
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4809
Mailing Address - Country:US
Mailing Address - Phone:847-226-0085
Mailing Address - Fax:847-770-4454
Practice Address - Street 1:801 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3009
Practice Address - Country:US
Practice Address - Phone:773-525-0081
Practice Address - Fax:773-525-0095
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363749972001Medicaid