Provider Demographics
NPI:1790869931
Name:FEDERSPILL, ROBERT ARNOLD (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ARNOLD
Last Name:FEDERSPILL
Suffix:
Gender:M
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:PO BOX 140
Mailing Address - Street 2:106 N MAIN ST
Mailing Address - City:ARLINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45814-0140
Mailing Address - Country:US
Mailing Address - Phone:419-365-5202
Mailing Address - Fax:419-365-5202
Practice Address - Street 1:106 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:OH
Practice Address - Zip Code:45814-0140
Practice Address - Country:US
Practice Address - Phone:419-365-5202
Practice Address - Fax:419-365-5202
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03210066183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0605018Medicaid
OH0178010001Medicare NSC