Provider Demographics
NPI:1932324431
Name:MIGLIORI, ROBERT HENRY
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:HENRY
Last Name:MIGLIORI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:HENRY
Other - Last Name:MIGLIORI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:2881 N ARATA RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95215-9766
Mailing Address - Country:US
Mailing Address - Phone:209-931-3982
Mailing Address - Fax:209-948-9307
Practice Address - Street 1:2525 E FREMONT ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95205-3906
Practice Address - Country:US
Practice Address - Phone:209-948-0546
Practice Address - Fax:209-948-9307
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH30145183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist