Provider Demographics
NPI:1174658082
Name:PELOT, ROBERT L (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:L
Last Name:PELOT
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 1:831 MANATEE AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1243
Mailing Address - Country:US
Mailing Address - Phone:941-748-8130
Mailing Address - Fax:941-749-5406
Practice Address - Street 1:831 MANATEE AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1243
Practice Address - Country:US
Practice Address - Phone:941-748-8130
Practice Address - Fax:941-749-5406
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0012705183500000X
FLPH24703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102234200Medicaid
FL0732610001Medicare NSC