Provider Demographics
NPI:1679061535
Name:POWELL, ROBERT MICHAEL
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MICHAEL
Last Name:POWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-2018
Mailing Address - Country:US
Mailing Address - Phone:931-685-1099
Mailing Address - Fax:931-685-1097
Practice Address - Street 1:1880 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2018
Practice Address - Country:US
Practice Address - Phone:931-685-1099
Practice Address - Fax:931-685-1097
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6810183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist