Provider Demographics
NPI:1174834675
Name:MARCUS, ROBERT JEROME (PHD, RPH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JEROME
Last Name:MARCUS
Suffix:
Gender:M
Credentials:PHD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31910 CASTAIC RD
Mailing Address - Street 2:
Mailing Address - City:CASTAIC
Mailing Address - State:CA
Mailing Address - Zip Code:91384-3929
Mailing Address - Country:US
Mailing Address - Phone:661-295-0966
Mailing Address - Fax:
Practice Address - Street 1:6201 VALLEY CIRCLE BLVD
Practice Address - Street 2:UNIT 3
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-1154
Practice Address - Country:US
Practice Address - Phone:818-702-8920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 22965183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist