Provider Demographics
NPI:1952125502
Name:BADEEN, ROBERT LOUIS JR (RPH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LOUIS
Last Name:BADEEN
Suffix:JR
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 1:11009 MIDBURY CT
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-3931
Mailing Address - Country:US
Mailing Address - Phone:512-934-1019
Mailing Address - Fax:
Practice Address - Street 1:1101 S CAPITAL OF TEXAS HWY STE F101
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-7075
Practice Address - Country:US
Practice Address - Phone:512-892-0490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8873332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site