Provider Demographics
NPI:1376605022
Name:KINGSCOTT, ROBERT PAUL (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:PAUL
Last Name:KINGSCOTT
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 1:965 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1211
Mailing Address - Country:US
Mailing Address - Phone:313-640-8394
Mailing Address - Fax:
Practice Address - Street 1:21811 KELLY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-2793
Practice Address - Country:US
Practice Address - Phone:586-498-7600
Practice Address - Fax:586-498-2011
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020271371835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric