Provider Demographics
NPI:1528056983
Name:KETCHUM, ROBERT M (RPH, MS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:KETCHUM
Suffix:
Gender:M
Credentials:RPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2244 VANESSA DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-4430
Mailing Address - Country:US
Mailing Address - Phone:205-991-0462
Mailing Address - Fax:205-991-0462
Practice Address - Street 1:2244 VANESSA DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-4430
Practice Address - Country:US
Practice Address - Phone:205-991-0462
Practice Address - Fax:205-991-0462
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7815183500000X
SC4434183500000X
TN33380183500000X
HI2987183500000X
TX48107183500000X
MS10637183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist