Provider Demographics
NPI:1528102548
Name:ROBINSON, ZACK L
Entity type:Individual
Prefix:MR
First Name:ZACK
Middle Name:L
Last Name:ROBINSON
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 1:202 LADUE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:IL
Mailing Address - Zip Code:62863
Mailing Address - Country:US
Mailing Address - Phone:161-826-2543
Mailing Address - Fax:
Practice Address - Street 1:1325 W 9TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:IL
Practice Address - Zip Code:62863-2906
Practice Address - Country:US
Practice Address - Phone:161-826-3454
Practice Address - Fax:161-826-2529
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist