Healthcare Provider Details

I. General information

NPI: 1033274725
Provider Name (Legal Business Name): ROBERT NATHAN SYKES JR. PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/25/2006
Last Update Date: 06/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 HICKORY FORK RD
EDENTON NC
27932-9566
US

IV. Provider business mailing address

PO BOX 345
EDENTON NC
27932-0345
US

V. Phone/Fax

Practice location:
  • Phone: 252-482-9991
  • Fax: 252-482-9991
Mailing address:
  • Phone: 252-482-9991
  • Fax: 252-482-9991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5216
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: