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NPI Code Detail

MEDICARE: MR. ROBERT T BEAN RPH

MEDICARE: MR. ROBERT T BEAN RPH
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
1183500000XPharmacistIL

General Provider Information

NPI Number : 1154308047
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROBERT T BEAN RPH
Provider Business Mailing Address
First Line : 17 BANDECON WAY
Second Line :
City : BLOOMINGTON
State : IL
Zip : 61704-8194
Country : US
Telephone Number : 309-663-7311
Fax Number :
Provider Business Practice Location Address
First Line : 1304 FRANKLIN AVE
Second Line : ATRIUM PHARMACY
City : NORMAL
State : IL
Zip : 61761-3558
Country : US
Telephone Number : 309-268-5783
Fax Number : 309-268-5524
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2005
Last Update Date : 07/08/2007

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