Provider Demographics
NPI:1356593990
Name:PROBERT, DAVID JOEL (RPH)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JOEL
Last Name:PROBERT
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 1:518 JEFFERSON PLAZA
Mailing Address - Street 2:
Mailing Address - City:PORT JEFF STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776
Mailing Address - Country:US
Mailing Address - Phone:631-476-8334
Mailing Address - Fax:631-476-0749
Practice Address - Street 1:518 JEFFERSON PLAZA
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:PORT JEFF
Practice Address - State:NY
Practice Address - Zip Code:11776
Practice Address - Country:US
Practice Address - Phone:631-476-8334
Practice Address - Fax:631-476-8334
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027950183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist