Provider Demographics
NPI:1144582545
Name:NOLAN, ROBERT GEORGE (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:GEORGE
Last Name:NOLAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E 90TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-7340
Mailing Address - Country:US
Mailing Address - Phone:563-285-2613
Mailing Address - Fax:563-285-2655
Practice Address - Street 1:250 E 90TH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-7340
Practice Address - Country:US
Practice Address - Phone:563-285-2613
Practice Address - Fax:563-285-2655
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA13960183500000X
TN22453183500000X
AZ15918183500000X
NE12143183500000X
MST-12306183500000X
KY14159183500000X
OR11724183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist