Provider Demographics
NPI:1265712632
Name:ANDERSON, ROBIN Y (RPH)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:Y
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 BERKELEY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-1414
Mailing Address - Country:US
Mailing Address - Phone:803-254-1287
Mailing Address - Fax:803-254-1287
Practice Address - Street 1:1500 BERKELEY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-1414
Practice Address - Country:US
Practice Address - Phone:803-254-1287
Practice Address - Fax:803-254-1287
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6444183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist