MEDICARE: ROBERT ALLEN STRUBLE III

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
1	183500000X	Pharmacist	5302031512	MI

General Provider Information

NPI Number	:	1235414434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT ALLEN STRUBLE III

Provider Business Mailing Address
First Line	:	5703 S SAGINAW RD
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-4459
Country	:	US
Telephone Number	:	810-695-4623
Fax Number	:	810-695-4188

Provider Business Practice Location Address
First Line	:	5703 S SAGINAW RD
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-4459
Country	:	US
Telephone Number	:	810-695-4623
Fax Number	:	810-695-4188

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2011
Last Update Date	:	10/19/2011

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Directions to “ ROBERT ALLEN STRUBLE III ” Practice Location

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