Provider Demographics
NPI:1083973127
Name:SMALL, ROBERT MICHAEL (REGISTERED PHARMACIS)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:SMALL
Suffix:
Gender:M
Credentials:REGISTERED PHARMACIS
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Mailing Address - Street 1:200 UCLS MEDICAL PLAZA, SUITE 135
Mailing Address - Street 2:LEVEL ONE UCLA MEDICAL PLAZA PHARMACY
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-6949
Mailing Address - Country:US
Mailing Address - Phone:310-794-1176
Mailing Address - Fax:310-794-1187
Practice Address - Street 1:200 UCLS MEDICAL PLAZA, SUITE 135
Practice Address - Street 2:LEVEL ONE UCLA MEDICAL PLAZA PHARMACY
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-6949
Practice Address - Country:US
Practice Address - Phone:310-794-1176
Practice Address - Fax:310-794-1187
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA24709183500000X
UT138342-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist