MEDICARE: RAYMOND R ROBSON III RPH., DPH.

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	03-2-25118	OH

General Provider Information

NPI Number	:	1245434117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND R ROBSON III RPH., DPH.

Provider Business Mailing Address
First Line	:	495 PRIMROSE LN
Second Line	:
City	:	MC DERMOTT
State	:	OH
Zip	:	45652-8941
Country	:	US
Telephone Number	:	740-259-2984
Fax Number	:

Provider Business Practice Location Address
First Line	:	495 PRIMROSE LN
Second Line	:
City	:	MC DERMOTT
State	:	OH
Zip	:	45652-8941
Country	:	US
Telephone Number	:	740-259-2984
Fax Number	:

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

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	07/08/2007

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