Provider Demographics
NPI:1184937104
Name:IRWIN, ROBERT ELLIS (RPH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ELLIS
Last Name:IRWIN
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 1:315 COLONNADE BLVD
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-2321
Mailing Address - Country:US
Mailing Address - Phone:814-861-8935
Mailing Address - Fax:814-861-8935
Practice Address - Street 1:315 COLONNADE BLVD
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-2321
Practice Address - Country:US
Practice Address - Phone:814-861-8935
Practice Address - Fax:814-861-8935
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP033585L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist