Provider Demographics
NPI:1265769277
Name:GUSTASHAW, ROBERT S (RPH)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:GUSTASHAW
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 1:1818 WEST DIXON BLVD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3914
Mailing Address - Country:US
Mailing Address - Phone:704-482-5401
Mailing Address - Fax:704-487-5199
Practice Address - Street 1:1818 W DIXON BLVD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-4351
Practice Address - Country:US
Practice Address - Phone:704-481-1784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-11
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6568183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist