Provider Demographics
NPI:1093856288
Name:ROBERTS, MICHAEL C (PD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 GIDDINGS AVE
Mailing Address - Street 2:SUITE L-1
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1411
Mailing Address - Country:US
Mailing Address - Phone:410-263-7440
Mailing Address - Fax:410-269-5947
Practice Address - Street 1:703 GIDDINGS AVE
Practice Address - Street 2:SUITEW L-1
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1411
Practice Address - Country:US
Practice Address - Phone:410-263-7440
Practice Address - Fax:410-269-5947
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist