Provider Demographics
NPI:1306280136
Name:PHELPS, ROB (RPH)
Entity type:Individual
Prefix:MR
First Name:ROB
Middle Name:
Last Name:PHELPS
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 1:4319 MEDICAL DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3381
Mailing Address - Country:US
Mailing Address - Phone:210-615-7475
Mailing Address - Fax:210-614-0804
Practice Address - Street 1:4319 MEDICAL DR
Practice Address - Street 2:SUITE 250
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3381
Practice Address - Country:US
Practice Address - Phone:210-615-7475
Practice Address - Fax:210-614-0804
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34697183500000X
NY36530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist