Provider Demographics
NPI:1740594100
Name:ROBINSON, ELLEN GOLDBERG (RPH)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:GOLDBERG
Last Name:ROBINSON
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 1:12018 PERRIN BEITEL RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-2116
Mailing Address - Country:US
Mailing Address - Phone:210-655-9542
Mailing Address - Fax:210-655-9590
Practice Address - Street 1:12018 PERRIN BEITEL RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-2116
Practice Address - Country:US
Practice Address - Phone:210-655-9542
Practice Address - Fax:210-655-9590
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25060183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist