Provider Demographics
NPI:1184792483
Name:BABA, ROBERT MITSUO (RPH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MITSUO
Last Name:BABA
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 1:12115 NE 149 TH. ST. #943
Mailing Address - Street 2:
Mailing Address - City:BRUSH PRAIRIE
Mailing Address - State:WA
Mailing Address - Zip Code:98606
Mailing Address - Country:US
Mailing Address - Phone:360-256-8409
Mailing Address - Fax:
Practice Address - Street 1:12115 NE 149 TH. ST. #943
Practice Address - Street 2:
Practice Address - City:BRUSH PRAIRIE
Practice Address - State:WA
Practice Address - Zip Code:98606
Practice Address - Country:US
Practice Address - Phone:360-256-8409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22060183500000X
OR0009514183500000X
WA21616183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA21616OtherPHARMACIST STATE LICENSE
OR0009514OtherPHARMACIST STATE LICENSE