Provider Demographics
NPI:1477956142
Name:SWEENEY, ROBERT ANDREW
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ANDREW
Last Name:SWEENEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 SEMPLE FARM RD APT 206
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-1886
Mailing Address - Country:US
Mailing Address - Phone:609-217-1779
Mailing Address - Fax:
Practice Address - Street 1:13007 WARWICK BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-8315
Practice Address - Country:US
Practice Address - Phone:757-882-1074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202213489183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202213489OtherPHARMACIST LICENSE NUMBER