Provider Demographics
NPI:1700921350
Name:COOLIDGE, ROBERT T (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:T
Last Name:COOLIDGE
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 1:514 W ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-4714
Mailing Address - Country:US
Mailing Address - Phone:605-224-1901
Mailing Address - Fax:
Practice Address - Street 1:514 W ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-4714
Practice Address - Country:US
Practice Address - Phone:605-224-1901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4157183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist