Provider Demographics
NPI:1619257243
Name:RITTER, ROBERT LARRY (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LARRY
Last Name:RITTER
Suffix:
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 1:108 MANGROVE ESTATES CIR
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-5968
Mailing Address - Country:US
Mailing Address - Phone:734-277-5860
Mailing Address - Fax:
Practice Address - Street 1:108 MANGROVE ESTATES CIR
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-5968
Practice Address - Country:US
Practice Address - Phone:734-277-5860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 12716183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist