Provider Demographics
NPI:1043589864
Name:LOMINACK, ROBERT BENNETT (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:BENNETT
Last Name:LOMINACK
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 1:1419 CHAPIN RD.
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036
Mailing Address - Country:US
Mailing Address - Phone:803-345-0029
Mailing Address - Fax:803-345-1817
Practice Address - Street 1:1419 CHAPIN RD.
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036
Practice Address - Country:US
Practice Address - Phone:803-345-0029
Practice Address - Fax:803-345-1817
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5276183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist