Provider Demographics
NPI:1497069025
Name:WITT, ROBERT SCOTT (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:SCOTT
Last Name:WITT
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 1:317 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-5803
Mailing Address - Country:US
Mailing Address - Phone:207-778-3919
Mailing Address - Fax:
Practice Address - Street 1:317 MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-5803
Practice Address - Country:US
Practice Address - Phone:207-778-3919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4014183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist