Provider Demographics
NPI:1811081367
Name:RACK, L ROBERT (RPH)
Entity type:Individual
Prefix:MR
First Name:L
Middle Name:ROBERT
Last Name:RACK
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 1:404 BELFREY DRIVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:PA
Mailing Address - Zip Code:15037
Mailing Address - Country:US
Mailing Address - Phone:412-384-6583
Mailing Address - Fax:
Practice Address - Street 1:404 BELFREY DRIVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:PA
Practice Address - Zip Code:15037
Practice Address - Country:US
Practice Address - Phone:412-384-6583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP024362L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist