Healthcare Provider Details

I. General information

NPI: 1780689240
Provider Name (Legal Business Name): ROBERT H LOMENICK RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 E VAN DORN AVE
HOLLY SPRINGS MS
38635-3025
US

IV. Provider business mailing address

145 E VAN DORN AVE
HOLLY SPRINGS MS
38635-3025
US

V. Phone/Fax

Practice location:
  • Phone: 662-252-2446
  • Fax: 662-252-4379
Mailing address:
  • Phone: 662-252-2446
  • Fax: 662-252-4379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE06294
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: