Provider Demographics
NPI:1326119595
Name:POWLESS, ROBERT C (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:C
Last Name:POWLESS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BROOK LN
Mailing Address - Street 2:PO BOX 577
Mailing Address - City:FLORA
Mailing Address - State:IL
Mailing Address - Zip Code:62839-2608
Mailing Address - Country:US
Mailing Address - Phone:618-662-8638
Mailing Address - Fax:
Practice Address - Street 1:123 E NORTH AVE
Practice Address - Street 2:
Practice Address - City:FLORA
Practice Address - State:IL
Practice Address - Zip Code:62839-2028
Practice Address - Country:US
Practice Address - Phone:618-662-2174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist