Provider Demographics
NPI:1083923148
Name:VIDAL, ROBIN RASHAUN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:RASHAUN
Last Name:VIDAL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:ROBIN
Other - Middle Name:R
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:4642 OWENS BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-1225
Mailing Address - Country:US
Mailing Address - Phone:504-250-2679
Mailing Address - Fax:
Practice Address - Street 1:19640 HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-8666
Practice Address - Country:US
Practice Address - Phone:228-702-1856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-06
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18051183500000X
MS10626183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist