Provider Demographics
NPI:1982103255
Name:FOURNIER, ROBERT JAMES (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
Last Name:FOURNIER
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 1:2025 SYLVESTER RD UNIT J2
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-3577
Mailing Address - Country:US
Mailing Address - Phone:863-337-6939
Mailing Address - Fax:863-248-7682
Practice Address - Street 1:2025 SYLVESTER RD UNIT J2
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-3577
Practice Address - Country:US
Practice Address - Phone:863-337-6939
Practice Address - Fax:863-248-7682
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-01
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS28547183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS28547OtherSTATE OF FLORIDA DEPARTMENT OF HEALTH