Provider Demographics
NPI:1427398270
Name:GAINES, ROBERT TAYLOR SR (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:TAYLOR
Last Name:GAINES
Suffix:SR
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 1:6811 CHERRYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-1097
Mailing Address - Country:US
Mailing Address - Phone:301-248-9569
Mailing Address - Fax:240-624-2205
Practice Address - Street 1:6811 CHERRYFIELD RD
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-1097
Practice Address - Country:US
Practice Address - Phone:301-248-9569
Practice Address - Fax:240-624-2205
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH2174183500000X
MD07480183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist