Provider Demographics
NPI:1154328151
Name:ROBERTSON, TIMOTHY WALTER (RPH)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:WALTER
Last Name:ROBERTSON
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 1:10601 PURCELL RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-4436
Mailing Address - Country:US
Mailing Address - Phone:804-363-5114
Mailing Address - Fax:804-261-5631
Practice Address - Street 1:10250 STAPLES MILL RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3064
Practice Address - Country:US
Practice Address - Phone:804-591-4320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202010759183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist