Provider Demographics
NPI:1871840637
Name:BIRDSALL, ROBERT ARNOLD (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ARNOLD
Last Name:BIRDSALL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CONCORD CT
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-4100
Mailing Address - Country:US
Mailing Address - Phone:856-453-8436
Mailing Address - Fax:
Practice Address - Street 1:1130 HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-5988
Practice Address - Country:US
Practice Address - Phone:856-453-0294
Practice Address - Fax:856-453-0369
Is Sole Proprietor?:No
Enumeration Date:2012-08-12
Last Update Date:2012-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02847800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist