Provider Demographics
NPI:1275969974
Name:ROBERTS, CARMEN MAURY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:MAURY
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HIGHWAY 78 E
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-3831
Mailing Address - Country:US
Mailing Address - Phone:205-387-1463
Mailing Address - Fax:205-384-4070
Practice Address - Street 1:300 HIGHWAY 78 E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-3831
Practice Address - Country:US
Practice Address - Phone:205-387-1463
Practice Address - Fax:205-384-4070
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11674183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist