Provider Demographics
NPI:1457620734
Name:ROBBINS, MARK HENRY
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:HENRY
Last Name:ROBBINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4627 N MAPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-7738
Mailing Address - Country:US
Mailing Address - Phone:219-210-5120
Mailing Address - Fax:
Practice Address - Street 1:4627 N MAPLEWOOD DR
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-7738
Practice Address - Country:US
Practice Address - Phone:219-210-5120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019605A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist