Provider Demographics
NPI:1912050428
Name:ROBIN, CHRIS REGIS (PD)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:REGIS
Last Name:ROBIN
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1053 BEAR CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-6741
Mailing Address - Country:US
Mailing Address - Phone:337-332-3181
Mailing Address - Fax:
Practice Address - Street 1:1101 GRAND POINT AVE
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-3917
Practice Address - Country:US
Practice Address - Phone:337-332-5186
Practice Address - Fax:337-332-2661
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist