Healthcare Provider Details

I. General information

NPI: 1992154611
Provider Name (Legal Business Name): ROBERT GWIN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W STATE ST
NEW CASTLE PA
16101-1039
US

IV. Provider business mailing address

1144 BROOKSHIRE DR
NEW CASTLE PA
16101-3150
US

V. Phone/Fax

Practice location:
  • Phone: 724-944-9808
  • Fax:
Mailing address:
  • Phone: 724-944-9808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP449974
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: