=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720370125
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT FRANCIS SHUDER JR. PHARM-D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2011
-----------------------------------------------------
Last Update Date | 05/04/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 48 SOUTH OAK STREET RITE AID PHARMACY
-----------------------------------------------------
City | MOUNT CAMEL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17851-1897
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-339-3721
-----------------------------------------------------
Fax | 570-339-3691
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 48-50 SOUTH OAK ST
-----------------------------------------------------
City | MT. CARMEL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17834-1897
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-339-3721
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP437711
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------