Provider Demographics
NPI:1306461124
Name:ROBINSON, EDWARD CHARLES (RPH)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:CHARLES
Last Name:ROBINSON
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 1:13421 SEASIDE HARBOUR DR
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-7122
Mailing Address - Country:US
Mailing Address - Phone:813-545-5574
Mailing Address - Fax:
Practice Address - Street 1:1619 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3713
Practice Address - Country:US
Practice Address - Phone:239-772-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS21066183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10634200Medicaid