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General NPI Number Information
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NPI Number | 1548667322
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Entity Type | Individual
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Provider Name | ROBERT REVELS PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/22/2014
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Last Update Date | 11/22/2014
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Provider Practice Location Address
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Address Line | 108 W 8TH ST
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City | LUMBERTON
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State | NC
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Zip | 28358-4848
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Country | US
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Telephone | 910-272-5115
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 344
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City | PEMBROKE
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State | NC
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Zip | 28372-0344
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Country | US
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Telephone |
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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 | 14936
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License Number State | NC
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