Provider Demographics
NPI:1215116488
Name:QUEEN, ROBERT W (RPH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:W
Last Name:QUEEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1617 W NORTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-4276
Mailing Address - Country:US
Mailing Address - Phone:509-326-7022
Mailing Address - Fax:509-323-1933
Practice Address - Street 1:1617 W NORTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-4276
Practice Address - Country:US
Practice Address - Phone:509-326-7022
Practice Address - Fax:509-323-1933
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00018615183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist