Provider Demographics
NPI:1497038574
Name:ROBERTS, ZACHARY L (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:L
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2565 ALEXANDRA DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46074-5874
Mailing Address - Country:US
Mailing Address - Phone:317-919-2384
Mailing Address - Fax:
Practice Address - Street 1:12279 BLUFFTON ROAD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46809
Practice Address - Country:US
Practice Address - Phone:734-343-7606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-24
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26022083A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist