Provider Demographics
NPI:1861721771
Name:FRIEND, ROBERT T
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:T
Last Name:FRIEND
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:T
Other - Last Name:FRIEND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:839 GLENDALE RD
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-2316
Mailing Address - Country:US
Mailing Address - Phone:276-236-9027
Mailing Address - Fax:
Practice Address - Street 1:955 A EAST STUART DRIVE
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333
Practice Address - Country:US
Practice Address - Phone:276-238-0685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202004960183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist