Healthcare Provider Details

I. General information

NPI: 1225594385
Provider Name (Legal Business Name): ROBERT MIX PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1606 DOOLEY RD
CARDIFF MD
21160-1130
US

IV. Provider business mailing address

844 CHESNEY LN
BEL AIR MD
21014-2656
US

V. Phone/Fax

Practice location:
  • Phone: 410-452-9799
  • Fax: 410-452-9196
Mailing address:
  • Phone: 484-678-8964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25783
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: