Provider Demographics
NPI:1689974636
Name:WILLIS, ROBERT JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:WILLIS
Suffix:JR
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 1:6220 E 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-2747
Mailing Address - Country:US
Mailing Address - Phone:303-242-3535
Mailing Address - Fax:303-242-3527
Practice Address - Street 1:6220 E 14TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-2747
Practice Address - Country:US
Practice Address - Phone:303-242-3535
Practice Address - Fax:303-242-3527
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17848183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist