Provider Demographics
NPI:1861092272
Name:ZANE, ROBERT DANIEL (RPH)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:DANIEL
Last Name:ZANE
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 1:3806 POLUMBO DR.
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-7044
Mailing Address - Country:US
Mailing Address - Phone:813-493-4045
Mailing Address - Fax:
Practice Address - Street 1:2140 BLOOMINGDALE AVE
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-6210
Practice Address - Country:US
Practice Address - Phone:813-681-6481
Practice Address - Fax:813-684-7373
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35636183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist