=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801166764
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT MICHAEL MCMAHON RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2012
-----------------------------------------------------
Last Update Date | 11/30/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 MARKET ST STE 108B
-----------------------------------------------------
City | ST AUGUSTINE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32095-8803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-241-9002
-----------------------------------------------------
Fax | 954-975-3786
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 701 MARKET ST STE 108B
-----------------------------------------------------
City | ST AUGUSTINE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32095-8803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-415-1434
-----------------------------------------------------
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 | PS30180
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------