Provider Demographics
NPI:1902193105
Name:NIEDERMEYER, ROBERT MARTIN JR (PHARM D)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MARTIN
Last Name:NIEDERMEYER
Suffix:JR
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 1:2625 WOODMONT LANE
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090
Mailing Address - Country:US
Mailing Address - Phone:412-596-5144
Mailing Address - Fax:724-728-7259
Practice Address - Street 1:87 WAGNER ROAD
Practice Address - Street 2:
Practice Address - City:MONACA
Practice Address - State:PA
Practice Address - Zip Code:15061
Practice Address - Country:US
Practice Address - Phone:724-728-7259
Practice Address - Fax:724-728-7259
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP444447183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist