Provider Demographics
NPI:1346339876
Name:ROBERTSON, RAYMOND E (RPH)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:E
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 1:2001 N AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35504-7068
Mailing Address - Country:US
Mailing Address - Phone:205-221-4564
Mailing Address - Fax:205-221-4555
Practice Address - Street 1:2001 N AIRPORT RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35504-7068
Practice Address - Country:US
Practice Address - Phone:205-221-4564
Practice Address - Fax:205-221-4555
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7371183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist