Healthcare Provider Details

I. General information

NPI: 1720411408
Provider Name (Legal Business Name): ROBERT AARON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 IRVIN ST
CORNELIA GA
30531-3267
US

IV. Provider business mailing address

639 IRVIN ST
CORNELIA GA
30531-3267
US

V. Phone/Fax

Practice location:
  • Phone: 706-778-4918
  • Fax: 706-776-2502
Mailing address:
  • Phone: 706-778-4918
  • Fax: 706-776-2502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH015961
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: