Provider Demographics
NPI:1942347174
Name:CROCKER, ROBERT L (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:L
Last Name:CROCKER
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 1:3708 N MAIN ST
Mailing Address - Street 2:P O BOX 690
Mailing Address - City:FARMVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27828-1499
Mailing Address - Country:US
Mailing Address - Phone:252-753-2092
Mailing Address - Fax:252-753-2499
Practice Address - Street 1:3708 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:NC
Practice Address - Zip Code:27828-1499
Practice Address - Country:US
Practice Address - Phone:252-753-2092
Practice Address - Fax:252-753-2499
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5618183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist