Provider Demographics
NPI:1124623525
Name:DORSEY, ROBERT JOHN (RPH)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOHN
Last Name:DORSEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 PANORAMA LN
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-7152
Mailing Address - Country:US
Mailing Address - Phone:707-835-7611
Mailing Address - Fax:
Practice Address - Street 1:160 COFFEE POT DR
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-4505
Practice Address - Country:US
Practice Address - Phone:928-282-9541
Practice Address - Fax:928-282-9544
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS023125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist