Provider Demographics
NPI:1558683573
Name:ROBERTS, GENE (RPH)
Entity Type:Individual
Prefix:MR
First Name:GENE
Middle Name:
Last Name:ROBERTS
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 1:531 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-2409
Mailing Address - Country:US
Mailing Address - Phone:718-436-5501
Mailing Address - Fax:718-437-9490
Practice Address - Street 1:531 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-2409
Practice Address - Country:US
Practice Address - Phone:718-436-5501
Practice Address - Fax:718-437-9490
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035683183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist