Provider Demographics
NPI:1003189192
Name:NELMS, ROBERT
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:NELMS
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 1:944 WALFRED RD
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:BC
Mailing Address - Zip Code:V9C2P4
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:944 WALFRED RD
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:BC
Practice Address - Zip Code:V9C2P4
Practice Address - Country:CA
Practice Address - Phone:425-670-0233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-20
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00041953183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6128300Medicaid