Healthcare Provider Details

I. General information

NPI: 1346243995
Provider Name (Legal Business Name): ROBERT EDDY PITTMAN R.PH., MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

INDIAN HEALTH SERVICE 801 THOMPSON AVE, SUITE 300
ROCKVILLE MD
20852-1627
US

IV. Provider business mailing address

5703 RIDGEWAY AVE
ROCKVILLE MD
20851-1927
US

V. Phone/Fax

Practice location:
  • Phone: 301-443-1190
  • Fax: 301-443-8170
Mailing address:
  • Phone: 301-230-2439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8126
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: