Healthcare Provider Details

I. General information

NPI: 1861706277
Provider Name (Legal Business Name): ROBERT CHURCH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2010
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 W GRAY RD
GRAY ME
04039-9772
US

IV. Provider business mailing address

62 W GRAY RD
GRAY ME
04039-9772
US

V. Phone/Fax

Practice location:
  • Phone: 207-657-2333
  • Fax:
Mailing address:
  • Phone: 207-657-2333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPR3841
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: