Provider Demographics
NPI:1093833212
Name:CARSON, ROBERT W
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:W
Last Name:CARSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-1612
Mailing Address - Country:US
Mailing Address - Phone:804-798-3849
Mailing Address - Fax:804-261-5631
Practice Address - Street 1:10150 BROOK RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-6514
Practice Address - Country:US
Practice Address - Phone:804-261-1760
Practice Address - Fax:804-261-5631
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202005462183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist