Provider Demographics
NPI:1053396820
Name:RIST, ROBERT WILLIAM (RPH)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:WILLIAM
Last Name:RIST
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 1:61 CINDER CONE LP
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-0159
Mailing Address - Country:US
Mailing Address - Phone:530-893-1917
Mailing Address - Fax:
Practice Address - Street 1:280 COHASSET RD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2210
Practice Address - Country:US
Practice Address - Phone:530-879-5000
Practice Address - Fax:530-878-5040
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37139183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist