Provider Demographics
NPI:1942571906
Name:BLISS, ROBERT DEXTRELL (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DEXTRELL
Last Name:BLISS
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 1:900 49TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-6625
Mailing Address - Country:US
Mailing Address - Phone:727-327-8801
Mailing Address - Fax:727-321-4273
Practice Address - Street 1:900 49TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-6625
Practice Address - Country:US
Practice Address - Phone:727-327-8801
Practice Address - Fax:727-321-4273
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39376183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist