Provider Demographics
NPI:1548231103
Name:IRWIN, ROBERT M (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:M
Last Name:IRWIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:M
Other - Last Name:IRWIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:7170 TORY DR
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-9005
Mailing Address - Country:US
Mailing Address - Phone:616-662-0311
Mailing Address - Fax:
Practice Address - Street 1:7170 TORY DR
Practice Address - Street 2:
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-9005
Practice Address - Country:US
Practice Address - Phone:616-662-0311
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302020676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302020676OtherPHARMACY LICENSE