Provider Demographics
NPI:1326356882
Name:FREY, ROBIN (RPH)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:FREY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:LILLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:3818 ROSS RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-7367
Mailing Address - Country:US
Mailing Address - Phone:901-212-6112
Mailing Address - Fax:
Practice Address - Street 1:8912 NORTHWEST DR
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-2414
Practice Address - Country:US
Practice Address - Phone:662-393-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS8302183500000X
TN8646183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist