Provider Demographics
NPI:1215153499
Name:MCCRARY, ROBERT DONALD (RPH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DONALD
Last Name:MCCRARY
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 1:26 MERCUREY DR
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-1120
Mailing Address - Country:US
Mailing Address - Phone:504-305-3059
Mailing Address - Fax:
Practice Address - Street 1:8601 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:RIVER RIDGE
Practice Address - State:LA
Practice Address - Zip Code:70123-3510
Practice Address - Country:US
Practice Address - Phone:504-738-5785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10567183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1234397Medicaid
LA1925164OtherNAPB #