Provider Demographics
NPI:1306855101
Name:HERSH, ROBERT GERALD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GERALD
Last Name:HERSH
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 1:5895 E MARLIES AVE
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-3623
Mailing Address - Country:US
Mailing Address - Phone:805-583-8642
Mailing Address - Fax:
Practice Address - Street 1:353 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:FILLMORE
Practice Address - State:CA
Practice Address - Zip Code:93015-1920
Practice Address - Country:US
Practice Address - Phone:805-524-0052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24349183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA24349OtherPHARMACIST LICENSE