Provider Demographics
NPI:1295243665
Name:LEARK, ROBERT THOMAS (PHARMD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:THOMAS
Last Name:LEARK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 BORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-3206
Mailing Address - Country:US
Mailing Address - Phone:805-498-6675
Mailing Address - Fax:
Practice Address - Street 1:2333 BORCHARD RD
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-3206
Practice Address - Country:US
Practice Address - Phone:805-498-6675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60074183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist