Provider Demographics
NPI:1356773832
Name:MCGEE, ROBERT MARK (RPH)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MARK
Last Name:MCGEE
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 1:7826 HIGHWAY 107
Mailing Address - Street 2:
Mailing Address - City:MANSURA
Mailing Address - State:LA
Mailing Address - Zip Code:71350-4930
Mailing Address - Country:US
Mailing Address - Phone:318-477-0188
Mailing Address - Fax:318-409-4112
Practice Address - Street 1:1240 PHILLIP AVE
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-5944
Practice Address - Country:US
Practice Address - Phone:225-571-7615
Practice Address - Fax:337-466-3731
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15107183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA15107OtherPHARMACIST LICENSE