Provider Demographics
NPI:1992024418
Name:BLACKWOOD, ROBERT KEITH JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:KEITH
Last Name:BLACKWOOD
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:348 WINCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3936
Mailing Address - Country:US
Mailing Address - Phone:603-352-6969
Mailing Address - Fax:603-352-7936
Practice Address - Street 1:348 WINCHESTER ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3936
Practice Address - Country:US
Practice Address - Phone:603-352-6969
Practice Address - Fax:603-352-7936
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHR823183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist