Provider Demographics
NPI:1003418385
Name:ROBERTS, CLYDE LLOYD III
Entity Type:Individual
Prefix:MR
First Name:CLYDE
Middle Name:LLOYD
Last Name:ROBERTS
Suffix:III
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:CLYDE
Other - Middle Name:LLOYD
Other - Last Name:ROBERTS
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:401 CONSTANT FRIENDSHIP BLVD
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-2566
Mailing Address - Country:US
Mailing Address - Phone:410-569-9406
Mailing Address - Fax:410-569-4681
Practice Address - Street 1:401 CONSTANT FRIENDSHIP BLVD
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-2566
Practice Address - Country:US
Practice Address - Phone:410-569-9406
Practice Address - Fax:410-569-4681
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15255183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist