Provider Demographics
NPI:1962709717
Name:ROBINSON, ALFONSO GOMEZ (RPH)
Entity type:Individual
Prefix:
First Name:ALFONSO
Middle Name:GOMEZ
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 1:801 EAST LAKESHORE DRIVE
Mailing Address - Street 2:
Mailing Address - City:TUSKEGEE
Mailing Address - State:AL
Mailing Address - Zip Code:36083
Mailing Address - Country:US
Mailing Address - Phone:334-727-0479
Mailing Address - Fax:
Practice Address - Street 1:801 E LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:TUSKEGEE
Practice Address - State:AL
Practice Address - Zip Code:36083-1934
Practice Address - Country:US
Practice Address - Phone:334-727-0479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL107831835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist