Healthcare Provider Details

I. General information

NPI: 1801166764
Provider Name (Legal Business Name): ROBERT MICHAEL MCMAHON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 MARKET ST STE 108B
ST AUGUSTINE FL
32095-8803
US

IV. Provider business mailing address

701 MARKET ST STE 108B
ST AUGUSTINE FL
32095-8803
US

V. Phone/Fax

Practice location:
  • Phone: 877-241-9002
  • Fax: 954-975-3786
Mailing address:
  • Phone: 954-415-1434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS30180
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: