Provider Demographics
NPI:1205985355
Name:LANGDON, ROBERT BRAYTON (RPH)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:BRAYTON
Last Name:LANGDON
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 1:704 BELLINGER AVE
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-2131
Mailing Address - Country:US
Mailing Address - Phone:315-736-2122
Mailing Address - Fax:315-736-7396
Practice Address - Street 1:131 ORISKANY BLVD
Practice Address - Street 2:COLONIAL PHARMACY
Practice Address - City:WHITESBORO
Practice Address - State:NY
Practice Address - Zip Code:13492-1319
Practice Address - Country:US
Practice Address - Phone:315-736-2122
Practice Address - Fax:315-736-7396
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044547-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist