Provider Demographics
NPI:1336633205
Name:BLUE, ROBERT AUSTIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:AUSTIN
Last Name:BLUE
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 1:4704 SAMS PL
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-8386
Mailing Address - Country:US
Mailing Address - Phone:870-450-5633
Mailing Address - Fax:
Practice Address - Street 1:400 W MOULTRIE DR
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-1716
Practice Address - Country:US
Practice Address - Phone:870-763-7951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD14983183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist