Provider Demographics
NPI:1851571194
Name:NELSON, ROBERT R (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:R
Last Name:NELSON
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 1:4500 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11769-1012
Mailing Address - Country:US
Mailing Address - Phone:631-567-3184
Mailing Address - Fax:631-567-0424
Practice Address - Street 1:4500 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1012
Practice Address - Country:US
Practice Address - Phone:631-567-3184
Practice Address - Fax:631-567-0424
Is Sole Proprietor?:No
Enumeration Date:2007-11-03
Last Update Date:2007-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27537183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist