Basic Information
Provider Information
NPI: 1497968838
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: POLLARD
FirstName: ROBERT
MiddleName: LEE
NamePrefix:  
NameSuffix: JR.
Credential: RPH. MHA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 501 S 5TH AVE
Address2:  
City: YAKIMA
State: WA
PostalCode: 989023550
CountryCode: US
TelephoneNumber: 5094946700
FaxNumber: 5095736275
Practice Location
Address1: 1806 W LINCOLN AVE
Address2:  
City: YAKIMA
State: WA
PostalCode: 989022473
CountryCode: US
TelephoneNumber: 5094524520
FaxNumber: 5094525224
Other Information
ProviderEnumerationDate: 05/08/2007
LastUpdateDate: 02/11/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/11/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000XRPH0010712ORN Pharmacy Service ProvidersPharmacist 
183500000XPH00011739WAY Pharmacy Service ProvidersPharmacist 

No ID Information.


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