Provider Demographics
NPI:1205031374
Name:MAYES, ROBERT HENRY (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:HENRY
Last Name:MAYES
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 1:11209 COTILLION DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-1943
Mailing Address - Country:US
Mailing Address - Phone:972-804-2653
Mailing Address - Fax:972-682-5930
Practice Address - Street 1:10925 ESTATE LN STE 390
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-2383
Practice Address - Country:US
Practice Address - Phone:214-503-1250
Practice Address - Fax:214-503-6914
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25603183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist