Provider Demographics
NPI:1518970102
Name:SIMPSON, ROBERT P (CPHT; BIS; ABA;)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:P
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:CPHT; BIS; ABA;
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4646 JOHN R
Mailing Address - Street 2:118 CP OUTPATIENT PHARMACY
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-576-4616
Mailing Address - Fax:313-576-1105
Practice Address - Street 1:4646 JOHN R ST
Practice Address - Street 2:118 CP OUTPATIENT PHARMACY
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1916
Practice Address - Country:US
Practice Address - Phone:313-576-4616
Practice Address - Fax:313-576-1105
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC2215-0005-2205-336183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician