Provider Demographics
NPI:1972633105
Name:WHITEHEAD, ROBERT STEVEN (RPH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:STEVEN
Last Name:WHITEHEAD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 COLUMBUS PL
Mailing Address - Street 2:#S12D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-8200
Mailing Address - Country:US
Mailing Address - Phone:212-365-9797
Mailing Address - Fax:212-397-0116
Practice Address - Street 1:1419 6TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2512
Practice Address - Country:US
Practice Address - Phone:212-247-1538
Practice Address - Fax:212-397-0116
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049778-01183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist