Provider Demographics
NPI:1114138690
Name:MACBEAN, ROBERT ROY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ROY
Last Name:MACBEAN
Suffix:
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 1:9406 NW 22ND CT
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-9144
Mailing Address - Country:US
Mailing Address - Phone:360-571-0011
Mailing Address - Fax:
Practice Address - Street 1:1615 DELEWARE STREET
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632
Practice Address - Country:US
Practice Address - Phone:360-414-7793
Practice Address - Fax:360-442-6843
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61094183500000X
OR10670183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist