Basic Information
| Provider Information | |||||||||
| NPI: | 1962573378 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EPPS | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | DUANE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | R.PH. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 MOLLY LN | ||||||||
| Address2: | |||||||||
| City: | MINEOLA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757731317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035692961 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 910 E HOUSTON ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757028363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035799800 | ||||||||
| FaxNumber: | 9035922811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835X0200X | 25047 | TX | Y | Pharmacy Service Providers | Pharmacist | Oncology |
ID Information
| ID | Type | State | Issuer | Description | 4592374 | 01 | TX | NCPDP | OTHER |