Provider Demographics
NPI:1306287834
Name:POLAND, ROBERT MICHAEL (RPH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:POLAND
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 1:1510 PENMAN RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3744
Mailing Address - Country:US
Mailing Address - Phone:904-241-5171
Mailing Address - Fax:904-241-0347
Practice Address - Street 1:1510 PENMAN RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3744
Practice Address - Country:US
Practice Address - Phone:904-241-5171
Practice Address - Fax:904-241-0347
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS19244183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist