Provider Demographics
NPI:1558479907
Name:ROBINSON, FABIAN ANTHONY SR (RPH)
Entity Type:Individual
Prefix:MR
First Name:FABIAN
Middle Name:ANTHONY
Last Name:ROBINSON
Suffix:SR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-1332
Mailing Address - Country:US
Mailing Address - Phone:504-464-1528
Mailing Address - Fax:504-466-1524
Practice Address - Street 1:4320 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-1332
Practice Address - Country:US
Practice Address - Phone:504-464-1528
Practice Address - Fax:504-466-1524
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA10912OtherPHARMACIST LICENSE