Provider Demographics
NPI:1356479166
Name:LICIER, ROBERTO (PHARMD,MS)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:
Last Name:LICIER
Suffix:
Gender:M
Credentials:PHARMD,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 VALLEYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21087-1062
Mailing Address - Country:US
Mailing Address - Phone:410-877-7430
Mailing Address - Fax:
Practice Address - Street 1:1901 VALLEYBROOK DR
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21087-1062
Practice Address - Country:US
Practice Address - Phone:410-877-7430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10970183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist