=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205031374
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT HENRY MAYES RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10925 ESTATE LN STE 390
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75238-2383
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-503-1250
-----------------------------------------------------
Fax | 214-503-6914
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11209 COTILLION DR
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75228-1943
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-804-2653
-----------------------------------------------------
Fax | 972-682-5930
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 25603
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------