Provider Demographics
NPI:1013206895
Name:SPERRY, ROBERT (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:SPERRY
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 1:44416 W EDDIE WAY
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-6416
Mailing Address - Country:US
Mailing Address - Phone:509-475-7642
Mailing Address - Fax:
Practice Address - Street 1:41650 W MARICOPACG HWY.
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:83815
Practice Address - Country:US
Practice Address - Phone:520-568-3302
Practice Address - Fax:520-568-6294
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019129183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist