Provider Demographics
NPI:1952511628
Name:JUSTUS, ROBERT MATTHEW (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MATTHEW
Last Name:JUSTUS
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 1:1393 EWINGTON RD
Mailing Address - Street 2:PO BOX 155
Mailing Address - City:VINTON
Mailing Address - State:OH
Mailing Address - Zip Code:45686-8805
Mailing Address - Country:US
Mailing Address - Phone:740-388-0151
Mailing Address - Fax:740-384-1685
Practice Address - Street 1:120 W 2ND ST
Practice Address - Street 2:
Practice Address - City:WELLSTON
Practice Address - State:OH
Practice Address - Zip Code:45692-1435
Practice Address - Country:US
Practice Address - Phone:740-384-2174
Practice Address - Fax:740-384-1685
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-23316183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist