Provider Demographics
NPI:1609097328
Name:RHOADES, ROBERTA L (RPH, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:L
Last Name:RHOADES
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3631 SUNBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-6325
Mailing Address - Country:US
Mailing Address - Phone:253-678-2248
Mailing Address - Fax:
Practice Address - Street 1:2125 HIGHWAY 155 N
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-4809
Practice Address - Country:US
Practice Address - Phone:253-564-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00052791183500000X
LA17341183500000X
VA0202206742183500000X
GARPH023876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist