Provider Demographics
NPI:1346978731
Name:ROBERTS, JOHN JAMES III (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JAMES
Last Name:ROBERTS
Suffix:III
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 MOOSIC ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-2105
Mailing Address - Country:US
Mailing Address - Phone:570-347-6991
Mailing Address - Fax:570-347-0955
Practice Address - Street 1:1101 MOOSIC ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-2105
Practice Address - Country:US
Practice Address - Phone:570-347-6991
Practice Address - Fax:570-347-0955
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP457009183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist