Provider Demographics
NPI:1982819678
Name:DENMON, ROBERT CARROLL (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:CARROLL
Last Name:DENMON
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 1:7533 WEST LAKESHORE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107
Mailing Address - Country:US
Mailing Address - Phone:318-929-4877
Mailing Address - Fax:
Practice Address - Street 1:5604 HWY 3
Practice Address - Street 2:FREDS PHARMACY # 1534
Practice Address - City:BENTON
Practice Address - State:LA
Practice Address - Zip Code:71006
Practice Address - Country:US
Practice Address - Phone:318-746-0151
Practice Address - Fax:318-746-0153
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11505183500000X
TX23508183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist