Provider Demographics
NPI:1205168416
Name:MERCHANT, ROBERT EDEN (RPH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:EDEN
Last Name:MERCHANT
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 1:4400 FORT JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-1006
Mailing Address - Country:US
Mailing Address - Phone:803-782-8508
Mailing Address - Fax:803-738-1889
Practice Address - Street 1:4400 FORT JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1006
Practice Address - Country:US
Practice Address - Phone:803-782-8508
Practice Address - Fax:803-738-1889
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2010-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5370183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist