Provider Demographics
NPI:1548614548
Name:DEAN, ROBIN (PD)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 KMART PLZ
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-2850
Mailing Address - Country:US
Mailing Address - Phone:501-843-6265
Mailing Address - Fax:847-396-2761
Practice Address - Street 1:1 KMART PLZ
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-2850
Practice Address - Country:US
Practice Address - Phone:501-843-6265
Practice Address - Fax:847-396-2761
Is Sole Proprietor?:No
Enumeration Date:2016-04-16
Last Update Date:2016-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD07353183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist