Provider Demographics
NPI:1760662290
Name:ROBINSON'S HEALTH MART
Entity Type:Organization
Organization Name:ROBINSON'S HEALTH MART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-252-4171
Mailing Address - Street 1:108 E COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:38635-3002
Mailing Address - Country:US
Mailing Address - Phone:662-252-4171
Mailing Address - Fax:662-252-4171
Practice Address - Street 1:108 E COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:38635-3002
Practice Address - Country:US
Practice Address - Phone:662-252-4171
Practice Address - Fax:662-252-4171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS00994/01.13336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00330089Medicaid
MS4632530001Medicare NSC