Provider Demographics
NPI:1508998253
Name:PUMP, ROBERT RANDY (R PH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:RANDY
Last Name:PUMP
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5673 S 1900 W
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-2301
Mailing Address - Country:US
Mailing Address - Phone:801-825-8021
Mailing Address - Fax:
Practice Address - Street 1:5673 S 1900 W
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-2301
Practice Address - Country:US
Practice Address - Phone:801-825-8021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2017-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI03958183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist