Provider Demographics
NPI:1245573450
Name:STRUCK, ROBIN J (BS)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:J
Last Name:STRUCK
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 COUNTRY CENTER DR
Mailing Address - Street 2:
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81147-8935
Mailing Address - Country:US
Mailing Address - Phone:970-730-6006
Mailing Address - Fax:970-731-6015
Practice Address - Street 1:165 COUNTRY CENTER DR
Practice Address - Street 2:
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147-8935
Practice Address - Country:US
Practice Address - Phone:970-730-6006
Practice Address - Fax:970-731-6015
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15960183500000X
CA32577183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist