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NPI Code Detail

MEDICARE: DR. ROBERT LEE POULOS JR. PHARMD.

MEDICARE: DR. ROBERT LEE POULOS JR. PHARMD.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist35721SC

General Provider Information

NPI Number : 1013326198
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT LEE POULOS JR. PHARMD.
Provider Business Mailing Address
First Line : 4758 LIGHTKEEPERS WAY UNIT 23B
Second Line :
City : LITTLE RIVER
State : SC
Zip : 29566-7960
Country : US
Telephone Number : 843-530-0733
Fax Number :
Provider Business Practice Location Address
First Line : 3701 N KINGS HWY
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29577-2977
Country : US
Telephone Number : 843-448-9104
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2014
Last Update Date : 08/04/2014

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