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General NPI Number Information
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NPI Number | 1336633205
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Entity Type | Individual
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Provider Name | ROBERT AUSTIN BLUE PHARMD
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Gender | Male
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Dates
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Enumeration Date | 06/14/2018
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Last Update Date | 12/11/2019
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Provider Practice Location Address
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Address Line | 400 W MOULTRIE DR
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City | BLYTHEVILLE
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State | AR
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Zip | 72315-1716
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Country | US
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Telephone | 870-763-7951
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Fax |
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Provider Business Mailing Address
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Address Line | 4704 SAMS PL
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City | JONESBORO
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State | AR
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Zip | 72404-8386
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Country | US
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Telephone | 870-450-5633
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PD14983
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License Number State | AR
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