Provider Demographics
NPI:1528407483
Name:MAYER, ROBERT J SR
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:MAYER
Suffix:SR
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 1:860 ARNOLD COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-2164
Mailing Address - Country:US
Mailing Address - Phone:636-282-4817
Mailing Address - Fax:636-282-4833
Practice Address - Street 1:860 ARNOLD COMMONS DR
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-2164
Practice Address - Country:US
Practice Address - Phone:636-282-4817
Practice Address - Fax:636-282-4833
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042046183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist