Provider Demographics
NPI:1386654622
Name:ROBERTS PHARMACY, INC.
Entity Type:Organization
Organization Name:ROBERTS PHARMACY, INC.
Other - Org Name:ROBERTS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOIACONO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-542-2191
Mailing Address - Street 1:1633 CAPE CORAL PKWY E
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-9624
Mailing Address - Country:US
Mailing Address - Phone:239-542-2191
Mailing Address - Fax:239-542-2192
Practice Address - Street 1:1633 CAPE CORAL PKWY E
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-9624
Practice Address - Country:US
Practice Address - Phone:239-542-2191
Practice Address - Fax:239-542-2192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21979261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center