Provider Demographics
NPI:1144810383
Name:ANDERSON, ROB F (RPH)
Entity type:Individual
Prefix:
First Name:ROB
Middle Name:F
Last Name:ANDERSON
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 1:601 WATER ST S
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-2434
Mailing Address - Country:US
Mailing Address - Phone:507-663-0344
Mailing Address - Fax:507-663-8934
Practice Address - Street 1:601 WATER ST S
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-2434
Practice Address - Country:US
Practice Address - Phone:507-663-0344
Practice Address - Fax:507-663-8934
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113120183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN305058100Medicaid