Provider Demographics
NPI:1497038079
Name:ROBIN, BEA PATTHANA (RPH)
Entity Type:Individual
Prefix:
First Name:BEA
Middle Name:PATTHANA
Last Name:ROBIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 HAYRACK DR
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-6375
Mailing Address - Country:US
Mailing Address - Phone:847-722-7681
Mailing Address - Fax:
Practice Address - Street 1:290 RANDALL RD
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-2274
Practice Address - Country:US
Practice Address - Phone:847-289-1095
Practice Address - Fax:847-289-1173
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.288550183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist