Provider Demographics
NPI:1558797084
Name:ROBERTSON, CHARLES E II (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:E
Last Name:ROBERTSON
Suffix:II
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 1:5950 STATE BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-6438
Mailing Address - Country:US
Mailing Address - Phone:678-258-1000
Mailing Address - Fax:
Practice Address - Street 1:5950 STATE BRIDGE RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-6438
Practice Address - Country:US
Practice Address - Phone:678-258-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH027480183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist