Provider Demographics
NPI:1225594385
Name:MIX, ROBERT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:MIX
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 1:844 CHESNEY LN
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-2656
Mailing Address - Country:US
Mailing Address - Phone:484-678-8964
Mailing Address - Fax:
Practice Address - Street 1:1606 DOOLEY RD
Practice Address - Street 2:
Practice Address - City:CARDIFF
Practice Address - State:MD
Practice Address - Zip Code:21160-1130
Practice Address - Country:US
Practice Address - Phone:410-452-9799
Practice Address - Fax:410-452-9196
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25783183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist