Provider Demographics
NPI:1780079723
Name:ROBINSON, AUDREY (PHARMD)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1897 PALM BEACH LAKES BLVD
Mailing Address - Street 2:SUITE115
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-3507
Mailing Address - Country:US
Mailing Address - Phone:561-822-3511
Mailing Address - Fax:
Practice Address - Street 1:1897 PALM BEACH LAKES BLVD
Practice Address - Street 2:SUITE115
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-3507
Practice Address - Country:US
Practice Address - Phone:561-822-3511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36939183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS36939OtherDEPT OF HEALTH STATE OF FLORIDA