Healthcare Provider Details

I. General information

NPI: 1154308047
Provider Name (Legal Business Name): ROBERT T BEAN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 FRANKLIN AVE ATRIUM PHARMACY
NORMAL IL
61761-3558
US

IV. Provider business mailing address

17 BANDECON WAY
BLOOMINGTON IL
61704-8194
US

V. Phone/Fax

Practice location:
  • Phone: 309-268-5783
  • Fax: 309-268-5524
Mailing address:
  • Phone: 309-663-7311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: