Provider Demographics
NPI:1396032231
Name:GRESHAM, ROBERT (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:GRESHAM
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 1:2200 N DALLAS PKWY
Mailing Address - Street 2:T-1764
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4300
Mailing Address - Country:US
Mailing Address - Phone:972-473-6335
Mailing Address - Fax:
Practice Address - Street 1:2200 N DALLAS PKWY
Practice Address - Street 2:T-1764
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4300
Practice Address - Country:US
Practice Address - Phone:972-473-6335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39742183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist