Provider Demographics
NPI:1972972156
Name:BLAIR, ROBERT (RPH)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BLAIR
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 1:1819 BEAVER AVE
Mailing Address - Street 2:PRICE CHOPPER #1310
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-3815
Mailing Address - Country:US
Mailing Address - Phone:515-279-4382
Mailing Address - Fax:
Practice Address - Street 1:1819 BEAVER AVE
Practice Address - Street 2:PRICE CHOPPER #1310
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-3815
Practice Address - Country:US
Practice Address - Phone:515-279-4382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16348183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist