Provider Demographics
NPI:1437658689
Name:ROBERTS, ROBERT III (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:ROBERTS
Suffix:III
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 1:26258 POLLARD RD
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4250
Mailing Address - Country:US
Mailing Address - Phone:251-380-7630
Mailing Address - Fax:
Practice Address - Street 1:26258 POLLARD RD
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4250
Practice Address - Country:US
Practice Address - Phone:251-380-7630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12683183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist