Provider Demographics
NPI:1720289242
Name:BOSWELL, ROBIN KAY MCKASSON (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:KAY MCKASSON
Last Name:BOSWELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11865 GOODALE AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-2608
Mailing Address - Country:US
Mailing Address - Phone:714-531-8746
Mailing Address - Fax:
Practice Address - Street 1:18395 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6705
Practice Address - Country:US
Practice Address - Phone:714-965-1973
Practice Address - Fax:714-964-0452
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41519183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist