Provider Demographics
NPI:1790371151
Name:IACOBUCCI, ROBERT J (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:J
Last Name:IACOBUCCI
Suffix:
Gender:M
Credentials:RPH
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Mailing Address - Street 1:11 BLACKSTONE VALLEY PL
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-1185
Mailing Address - Country:US
Mailing Address - Phone:401-726-6200
Mailing Address - Fax:401-351-5902
Practice Address - Street 1:11 BLACKSTONE VALLEY PL
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-1185
Practice Address - Country:US
Practice Address - Phone:401-726-6200
Practice Address - Fax:401-351-5902
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIRPH03996183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist