Basic Information
| Provider Information | |||||||||
| NPI: | 1780022673 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAPP | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | ERIC | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | R.PH. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 505 LEMANS WAY | ||||||||
| Address2: | |||||||||
| City: | FAIRVIEW HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622083648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182338296 | ||||||||
| FaxNumber: | 8883915687 | ||||||||
| Practice Location | |||||||||
| Address1: | 126 MISSOURI AVE | ||||||||
| Address2: | |||||||||
| City: | FORT LEONARD WOOD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 654738952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5735960514 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2013 | ||||||||
| LastUpdateDate: | 06/12/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 041519 | MO | Y | Pharmacy Service Providers | Pharmacist | 183500000X | 051-035981 | IL | N | Pharmacy Service Providers | Pharmacist |
No ID Information.