Healthcare Provider Details

I. General information

NPI: 1568458677
Provider Name (Legal Business Name): ROBERT CHARLES HORN P.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 HIGHWAY 425 N
MONTICELLO AR
71655-4015
US

IV. Provider business mailing address

PO BOX 268 203 JACI LANE
MONTICELLO AR
71657-0268
US

V. Phone/Fax

Practice location:
  • Phone: 870-367-3559
  • Fax: 870-367-5086
Mailing address:
  • Phone: 870-460-9064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberAR7228
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: