Provider Demographics
NPI:1407527740
Name:COLBURN, ROBERT MAYNARD JR (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MAYNARD
Last Name:COLBURN
Suffix:JR
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 1:909 MCFARLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476-3373
Mailing Address - Country:US
Mailing Address - Phone:205-339-5800
Mailing Address - Fax:205-339-5851
Practice Address - Street 1:909 MCFARLAND BLVD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476-3373
Practice Address - Country:US
Practice Address - Phone:205-339-5800
Practice Address - Fax:205-339-5851
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10682183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist