Provider Demographics
NPI:1275976847
Name:ROBBINS, MARK (RPH, CGP)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:ROBBINS
Suffix:
Gender:M
Credentials:RPH, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 NE 112TH AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-7262
Mailing Address - Country:US
Mailing Address - Phone:360-892-8688
Mailing Address - Fax:
Practice Address - Street 1:3002 NE 112TH AVE
Practice Address - Street 2:SUITE F
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-7262
Practice Address - Country:US
Practice Address - Phone:360-892-8688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00017689183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist