Provider Demographics
NPI:1386981389
Name:MACLEAN, ROBERT MATTHEW (RPH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MATTHEW
Last Name:MACLEAN
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 1:7780 MCGINNIS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1622
Mailing Address - Country:US
Mailing Address - Phone:770-622-2652
Mailing Address - Fax:770-622-2756
Practice Address - Street 1:7780 MCGINNIS FERRY RD
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1622
Practice Address - Country:US
Practice Address - Phone:770-622-2652
Practice Address - Fax:770-622-2756
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH018383183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist