Provider Demographics
NPI:1801800024
Name:LINCICOME, ROBERT D (RPH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:D
Last Name:LINCICOME
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 1:7 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105-3329
Mailing Address - Country:US
Mailing Address - Phone:304-295-4936
Mailing Address - Fax:
Practice Address - Street 1:7 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:WV
Practice Address - Zip Code:26105-3329
Practice Address - Country:US
Practice Address - Phone:304-295-4936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2968183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist