Provider Demographics
NPI:1528288685
Name:ROBY, BRONDA ANNE BROY (RPH)
Entity type:Individual
Prefix:MRS
First Name:BRONDA
Middle Name:ANNE BROY
Last Name:ROBY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WHEELER CT
Mailing Address - Street 2:
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611-4354
Mailing Address - Country:US
Mailing Address - Phone:309-699-7983
Mailing Address - Fax:309-699-7983
Practice Address - Street 1:2540 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611
Practice Address - Country:US
Practice Address - Phone:309-698-3145
Practice Address - Fax:309-694-2768
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist