Provider Demographics
NPI:1770183691
Name:BIACHE, ROBERT PERRY (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:PERRY
Last Name:BIACHE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6009 S LAKEPOINT DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2568
Mailing Address - Country:US
Mailing Address - Phone:417-844-4595
Mailing Address - Fax:
Practice Address - Street 1:3315 S CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-4914
Practice Address - Country:US
Practice Address - Phone:417-881-6750
Practice Address - Fax:417-881-6732
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044705183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist