Provider Demographics
NPI:1487009205
Name:ROBERTSON, COLVIN EARL JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:COLVIN
Middle Name:EARL
Last Name:ROBERTSON
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4801 TROUP HWY STE 402
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-2358
Mailing Address - Country:US
Mailing Address - Phone:039-617-6885
Mailing Address - Fax:903-792-9114
Practice Address - Street 1:13027 STATE HIGHWAY 155 S STE 200
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-6564
Practice Address - Country:US
Practice Address - Phone:430-562-9003
Practice Address - Fax:430-562-9004
Is Sole Proprietor?:No
Enumeration Date:2016-04-29
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48543183500000X
FLPS36568183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist