Provider Demographics
NPI:1871775064
Name:MAYNARD, ROBERT JOSEPH (PHARM D)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:MAYNARD
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-1827
Mailing Address - Country:US
Mailing Address - Phone:716-684-0972
Mailing Address - Fax:
Practice Address - Street 1:13090 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ALDEN
Practice Address - State:NY
Practice Address - Zip Code:14004-1202
Practice Address - Country:US
Practice Address - Phone:716-937-9141
Practice Address - Fax:716-937-4728
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051916183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist