Provider Demographics
NPI:1790829737
Name:ROBINSON, PHYLLIS L (RPH)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:L
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 KAUMANA DR
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-1818
Mailing Address - Country:US
Mailing Address - Phone:808-896-9784
Mailing Address - Fax:808-961-0076
Practice Address - Street 1:45-3551 MAMANE ST STE A4
Practice Address - Street 2:
Practice Address - City:HONOKAA
Practice Address - State:HI
Practice Address - Zip Code:96727-6926
Practice Address - Country:US
Practice Address - Phone:808-775-0496
Practice Address - Fax:808-775-1300
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-763183500000X
WY2139183500000X
CA39527183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist