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General NPI Number Information
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NPI Number | 1639602881
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Entity Type | Individual
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Provider Name | ROBERT GARGOL RPH
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Gender | Male
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Dates
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Enumeration Date | 04/05/2017
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Last Update Date | 04/05/2017
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Provider Practice Location Address
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Address Line | 1535 W MAUMEE
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City | ADRIAN
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State | MI
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Zip | 49221
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Country | US
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Telephone | 516-265-9162
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Fax |
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Provider Business Mailing Address
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Address Line | 1535 W MAUMEE
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City | ADRAIN
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State | MI
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Zip | 49221
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Country | US
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Telephone | 734-944-0330
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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 | 5302029228
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License Number State | MI
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