Provider Demographics
NPI:1093440232
Name:STEWART, ROBERT GARY JR (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:GARY
Last Name:STEWART
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 MEADOW CREST DR
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29172-2051
Mailing Address - Country:US
Mailing Address - Phone:803-873-0827
Mailing Address - Fax:
Practice Address - Street 1:1118 MACK ST
Practice Address - Street 2:
Practice Address - City:GASTON
Practice Address - State:SC
Practice Address - Zip Code:29053-8713
Practice Address - Country:US
Practice Address - Phone:803-939-8489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43543183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist