Provider Demographics
NPI:1235414434
Name:STRUBLE, ROBERT ALLEN III
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALLEN
Last Name:STRUBLE
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5703 S SAGINAW RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-4459
Mailing Address - Country:US
Mailing Address - Phone:810-695-4623
Mailing Address - Fax:810-695-4188
Practice Address - Street 1:5703 S SAGINAW RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-4459
Practice Address - Country:US
Practice Address - Phone:810-695-4623
Practice Address - Fax:810-695-4188
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031512183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist