Provider Demographics
NPI:1568743052
Name:LIBBY, ROBERT JASON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JASON
Last Name:LIBBY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N LAWRENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:KEYSTONE HEIGHTS
Mailing Address - State:FL
Mailing Address - Zip Code:32656-9351
Mailing Address - Country:US
Mailing Address - Phone:352-473-4621
Mailing Address - Fax:352-473-6614
Practice Address - Street 1:115 N LAWRENCE BLVD
Practice Address - Street 2:
Practice Address - City:KEYSTONE HEIGHTS
Practice Address - State:FL
Practice Address - Zip Code:32656-9351
Practice Address - Country:US
Practice Address - Phone:352-473-4621
Practice Address - Fax:352-473-6614
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS38093183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist