Provider Demographics
NPI:1518204460
Name:TIBERIA, ROBERT JOHN (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOHN
Last Name:TIBERIA
Suffix:
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 1:10928 CROSS CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-4034
Mailing Address - Country:US
Mailing Address - Phone:813-986-1827
Mailing Address - Fax:813-986-1995
Practice Address - Street 1:10928 CROSS CREEK BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-4034
Practice Address - Country:US
Practice Address - Phone:813-986-1827
Practice Address - Fax:813-986-1995
Is Sole Proprietor?:No
Enumeration Date:2013-01-12
Last Update Date:2013-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0019293183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist